MD refuses to sign a telephone order. - page 3

I'm a new grad working on my own for almost a month now, starting in ICU at a hospital where the acuity of the patients is rather low, so I consider it a SICU. I had a pt with a history of cvs with... Read More

  1. by   Onyameate
    Sorry to read your predicament. In the hospital where I work, the phrase :MD NOTIFIED or MD CALLED is never allowed. Every MD has a name. Next time you receive any order, ask and write the name of the MD first before you proceed.
  2. by   Onyameate
    The phrase "MD notified" is not acceptable in the hospital where I work. Every MD has a name. Next time ask the name of the MD or whoever is giving you orders, and write it in your documentation. This might help you and save you all the unexpected heartaches.
    This is why I like to read these blogs, because I learn so much. Although, I am not working at this time, I will implement having a second nurse verify the order, as it makes sense to avoid any misunderstandings.
    My question is do nurse mind doing this with each other? I ask this, because I would like to implement also the walk around when receiving report from a peer as well as giving it, so we are both on par on how we are receiving/giving the patients, but a friend told me that doing this will probably not make me a favorite in the unit as come time to go home, everyone wants to go home, not more to do.
  4. by   psu_213
    Quote from Onyameate
    The phrase "MD notified" is not acceptable in the hospital where I work. Every MD has a name. Next time ask the name of the MD or whoever is giving you orders, and write it in your documentation. This might help you and save you all the unexpected heartaches.
    It is not acceptable anywhere, particularly if you are taking a verbal order. I basically trust all the ER attendings with whom I work; however, they get busy too. If I tell them about a critical lab result that does not get fixed, and the pt has a negative outcome as a result, just charting "MD aware" is not going to save me.
  5. by   tri-rn
    Have to agree with Netglow...the OP is new. She mis-spoke, or maybe isn't clear on the differences between types of ICU's having only experienced the one she's in. How about we help her out by explaining the difference instead of eating our young. Pleaseandthanks.
  6. by   08RNGrad
    I would think as long as you stated the MDs name and wrote TORD you would be FINE. Good luck.
  7. by   cmbuckley
    Recently worked in an ED where telephone orders were taken by the ED RN for newly admitted patients. Such abuse I have never seen 3 pages worth which included all tests for the duration of the patients stay. All medications irregardless of when they were due to start and for drug levels ie: vancomycin peak and trough that wouldn`t occur for 36 hours post taking these orders.This process could take a half an hour and mean while the ED RN is still getting new ED patients. It was not unusual for that same MD to appear in the ED an hour later to do their H + P, sign the orders and leave.! I did not trust all these MD`S and would have an order verified by a second RN. This was not normal practice and not looked upon kindly however in the one other hospital I worked in where telephone orders were allowed it was and then only emergent orders it was policy. Telephone Orders should be banned.
  8. by   psu_213
    There is a place for telephone orders (i.e. a true emergency). They are not appropriate for routine admitting orders in the ER, not appropriate when the MD wants call back an order he forgot just after he left the floor, and not really necessary for routine DVT prophylaxis orders.

    I'm with some of the others who say that if this doctor is not going to sign TO's, then the nursing staff has to get together and refuse to take them from him/her. Today it is something fairly benign like Lovenox, next time it is a narc or a benzo and now someone's license really is in jeopardy.
  9. by   friendlyjane
    Yes, I thought that was pretty insulting as well. And the OP's scramble to say she meant "MICU" instead wasn't very flattering, either. A low acutity ICU is a low acuity ICU. MICUs can be pretty high acuity. But anyplace that has a MICU probably has another ICU as well . . . usually a SICU. Hospitals with more than one ICU are likely to have higher acuity patients than a small hospital that has just one ICU.
    Nope, none of us work with the OP, but the OP is the one who started the crap about the acuity of her workplace. Some of us found it insulting that the OP said she called her workplace a SICU because it was low acuity. Then some of us found it insulting when she said oh, no, she meant MICU. Perhaps the OP should apologize for denigrating SICUs and MICUs.
    WOW! Y'all are some rude nurses. I am still in pre-nursing for my BSN and I read because I am so intrested and eager about the nursing career. It is apparent to me that the OP may not have a clear understanding of what SICU or MICU is. Does that mean y'all should be so rude bc y'all think she is down playing the critical aspect of these ICU's. I did not read any intent of the OP to insult anyone or any unit. She was asking for help. She is a new nurse and that is scary as hell. Instead of help from some people she gets overly sensitive responses. Life is to short to be so rude to people with no ill intent so maybe y'all need to take a chill pill. Geeezzzz people!
  10. by   turnforthenurse
    Quote from sapphire18
    Even if you didn't know about the HIT test, always check platelet counts before giving lovenox.
    and heparin (obviously). Unfortunately not everyone checks their labs like they should. I was floated to ICU one night and had a patient receiving SQ heparin. They were already there for a few days and the platelet count definitely dropped >50% since they were started on heparin, but no one ever caught it or paid attention.