Cardiac meds to be given without an order?

[rn1820]

I was able to move from the bedside to a stress lab with a more stable environment and work hours. Many pros in the change. However, there's no orders for frequently given medications like dobutamine and lexiscan, which affect HR and BP--some fairly serious meds. 

Part of the issue, management says, stems from my state having different laws regarding nursing protocols than the protocols available at my hospital's sister locations in other states. It's "been done this way" for so long. Higher ups are looking into the creation of protocols (thanks to the Vaught case and voiced concerns from staff), but logistically, it could take months. Right now, we operate off nurse-made guidelines, which wouldn't hold up in court, don't have patient-specific orders or standing orders, and don't scan the medications into a MAR.

Apart from documenting meticulously and triple-checking my medication, any suggestions for how to protect my patients and myself through some kind of checking/documentation while the protocols are in limbo? Like typing the bottle number into my charting, having and noting an RN who double-checks my medication, etc? Charting system is EPIC. Or is there anything further myself and fellow nurses can do to help further the protocol/order creation?

Thanks in advance. 

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