Can doctors go against hospital policy?

[bellehill, RN]

We have a debate going on in my critical care unit and I would love some opinions. Our manager states that the doctors are able to write orders which go against hospital policy and we are to follow these orders. She told us that the doctor would be liable if something happened because it was their order; I disagree. Policies are in place for a reason and if we don't follow them what is the point of having them? My manager's rationale is that this specific policy was up for review and was going to be changed next month. What do you all think? Do the physician orders trump a hospital approved policy?

[feebebe23]

my hospital has a policy that states if a doc wants to go against hospital policy he/she has to notify the pt that the order is againts hospital policy and have a consent signed by the pt stating as such.......

whenever this has been brought up.....i have never had a doc go and tell the pt he/she wants to violate hospital policy

works like a charm

[*ac*]

I have explained to the doc that I will be writing a nursing note that says, "Per Dr. so and so..." and the doc has changed his mind in a heartbeat.

[racing-mom4, BSN, RN]

I have explained to the doc that I will be writing a nursing note that says, "Per Dr. so and so..." and the doc has changed his mind in a heartbeat.

Dont all orders say "per Dr so an so"?

[momdebo, BSN, RN]

As far as I know if you follow an order that opposes established policy then you are as liable as the ordering doctor, the hospital will not back you up. If a lawsuit arises they can name you both, together or in individual actions. As far as the policy being up for review, follow what is on the books at the time. Policies are dated just for this reason. They will check the date of the order against the dates of policies. To remain protected by the facility ALWAYS follow your current policy. Then if there is any action, it's all on the facility. Hope this helps.

[*ac*]

Dont all orders say "per Dr so an so"?

I often write, "as ordered". In this case, I'm warning the doctor that I will be writing his specific name down in a special nursing note which will explain why the protocol was not followed. I've never actually had to do it.

[bellehill, RN]

Thanks everyone. that is exactly how I felt about the situation. I don't see the hospital backing me up if I did not follow their policy. I am going to contact the legal department and get some clarification. Again, thanks!

[RN1982]

We had this same issue of docs going against hospital policy. We had a patient with a wound vac and the docs wanted the nurses to hook it up to wall suction instead of the suction machine used for wound vacs, a big no-no at my hospital.

[lpnflorida]

You pose an interesting question. We have multiple order sets which doctors can use, we also have an order set say for diabetics. It is long it is lengthy. Our physcians can choose to not enact the diabetic order set and therefore write out their own orders for their diabetic patient. While we have pressure ulcer policy and what would be best treatment yada yada . A doctor can still tweak that to what he wants or what he feels is best for his patient.

Perhaps I do not fully understand in what regards to policy? Yes, there are policies and then there are orders. Can you give an example so that I might understand?

[momdebo, BSN, RN]

The wound vac is an excellent example. The hospital has stated that no wound vac is to be attached to wall suction. The doctor is trying to order the nurse to put the wound vac to wall suction. He can order whatever he wants but the nurse must tell him she cannot do it. She should then advise her charge nurse and I would also tell him to discuss the issue with the charge nurse. If the nurse should follow the order which is clearly in violation of established policy then if that patient has a bad outcome as a result (wound injury, etc) then that nurse is the first one responsible, the hospital would have no fault in the matter because the nurse did something that the hospital clearly says not to do. Hope that helps.

[cookienay]

another example is that of moderate sedation. Our policies are very clear as to which circumstances warrant following the MS protocol of observation, precautions, documentation, consent, etc... However, sometimes our physicians will say "you don't need to do moderate sedation, just give the meds and observe". Ummm... no. I will follow the policy because I value my job. Another area for us was restraints. Some docs wanted us to restrain patients without making them a one on one or following the restraint protocol. What? so tie someone down and walk away? even if they are restrained for only 15 minutes that is still a no-no. So, in a nutshell, I would say that just because a doctor orders something that varies from the policy is not a reason to go against it. I have always allowed the docs the option of doing it themselves but for some reason they never take me up on it. hmmmm...

[lpnflorida]

Yes, I understand about wound vacs. equipment is equipment and has explicit instructions as to how to safely use the equipment. Our particular policy in regards to wound vacs more addresses how often it is to be changed rather than equipment as it is understood we follow manufacturers instructions in the setting up of the woundvac to thier particular machine which has preset pressure on it.

As far as restraint, our policy does not necessitate having 1:1. I realize this may vary from facility to facility. Restraints depending on what type might be q 15 min checks for leathers, q2 hours for soft wrist. Same as for 4 rails up.

It was any other example that I was wondering about.