crossing out MD orders??

[RNinSoCal]

Hello all,

I have not posted here before. Switched to MDS nurse (LTC) from med/surg for a change of pace. My feet still hurt from all the years of med/surg!! Not that LTC nursing is easier, just MDS work. I am helping to enter MD orders for the monthly physician order printouts (since the nurses here do not know how to use a computer and the medical records person is new). I noticed that the nurses are crossing out MD orders when an order is changed or DC'd. It is so strange to me. It seems wrong to cross out an MD order. In acute we would just write the DC or change in order and leave the older orders alone. Is this a common thing in LTC or just a totally wrong practice at this facility??? I am learning this is a different world from acute. It IS a nice change of pace though.

Thanks for any input.

[tokebi]

I'd be horrified if such practice is common. I've never seen such a thing at my LTC. We always write a new order if d/c'ed or changed. We do not mess with the orders that have been written.

Sometimes however, entries are crossed out in the monthly printout ("recap"), in case the printout is not up-to-date and does not match MAR, along with a note (d/c, or changed, or whatever) and date.

[P_RN, ADN, RN]

Not good at all. Not even a doc can cross our his./her own orders. I know this cause a doc tried it where I worked. Tried to say he never ordered a med that the pharmacy had profiled and the patient had received. Bad, bad, bad practice.

[RNinSoCal]

Thanks for responding! I thought it was wrong too. I asked the DON if it was done on all order pages or just the monthly printout and she said on any order sheet! State should have fun with her:eek: I am just the alternate MDS nurse, not in charge of pt care at all. Maybe she will ask someone since I questioned it.

[RN2B123]

I have always been taught to highlight D/C'd orders in yellow highlighter...if an order is changed we write the new order and then highlight the old one in yellow to show that it is has been discontinued

[Scarlette Wings]

I think there may a legal issue or two with just crossing out an order. I would contact the nursing board for your state and ask them the regulations for long term care. I would also check the facilities policy and procedure book. Even if that is the way "we've always done it" it is your license signing and working in those charts. Let us know what you find out. I can't imagine that it is a best practice standard even in long term care.

[jnrsmommy]

I guess I'm a little confused, are you saying the cross out the actual order, or just on the recap sheet? I know that when I do the recap orders, if the order has been discontinued, I normally highlight (or will cross out if I don't have my highlighter), write next to it, order changed or order d/c'd on such and such date, then I write a computer clarification order so that medical records can update the information.

[caliotter3]

You are dealing with several people who do not know or care about the correct way to handle changed or DC'd orders. Run across the same practices in home health quite frequently. Even after you show someone the correct way to do it, they still will scribble all over and get their feathers ruffled if the boss tells them to correct it.

[morte, LPN, LVN]

commonly done on the print outs of monthly orders, keep in mind these are NOT signed doctor's orders.....corrections are made, new orders added etc.....the doc is then responsible for reading before signing.

[mamamerlee, LPN]

Look for the policy / procedure on taking off orders. Sometimes the printoff for the next month is done 5-10 days early, and an order may have changed.

[ConfidentInMe30]

I have worked in longterm care in both the state of Illinois and Missouri, and it is common practice to cross out an old order that is written in the little boxes to the side and to write dc'd or changed and the date, and then to write a new order and this will stop the old order from reoccuring when you get your new Mar, Tar from the pharmacy. It shows that the order has been changed or dc'd and that there is a new order but a date should be written when you see the line to indicate when the order was stopped. we do not cross out the original written order that is written on the right side of the P.O.S. sheet. only the order that is rewritten in the boxes on the left. I hope this makes since and helps. and when i say cross out i mean a single line diagonally, not scribbles or anything else. we are not allowed to use highlighters on mars where i have worked

[sasha2lady]

ok...I work in LTC and im a little confused here..by what is meant by "crossing" off md orders....we still use the paper MARS....lets say...someone is on vitamin c 500mg po qd...md comes and says its needs to change...so he orders vitamin c 500 mg po bid...what we do is we write the order to d/c the qd order, then write it for bid....on the Mar....we write on the d/cd order "dc'd, changed, increased" or whatever applies...then write on the new one and the start date/time. We dont actually "mark" out the old orders...we highlight them out so there is no confusion. This has been done since Ive been a nurse and beyond where I work. Then again...I guess it all depends. another place I work prn isnt allowed to use any highlighters on the mars...so its all black and white and its extremely difficult to see whats current and whats not because its not highlighted. To me its makes sense...but again..not sure if this is exactly what you are talking about..or if people are marking out complete orders to where it looks like the order didnt exist to start with..if thats the case then yes...Id have to say that that is incorrect...esp if that med has been given and signed for. Make sense??