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.
MD order on regular order sheet " 6/15/10 Tylenol 650 mg po q 4 hours prn mild pain Dr. Knowitall" The nurse receives new telephone order from MD on 6/24/10 for Tylenol 325 mg q 4 instead of 650. She goes back to original order on 6/15/10draws a line through and writes changed then writes new/changed order. I do not understand why anyone whould draw a line through an older order on a regular order sheet. The new order is the valid one and the nurse needs to change the MAR not the MD order sheet. This is not just the printed re-cap it is happening on. I know it is bad nursing practice but as a previous poster said feathers will ruffle if I try to tell DON what to do. CHW (former employer) would have had a cow over this kind of nursing practice. I am happily doing MDS forms today.
Specializes in Gerontology, Med surg, Home Health.
I have four pillows filled with ruffled feathers! Do what is right...tell whom you need to tell and if it will save a med error or a patient issue, ruffle away!
I also do not understand why anyone would draw a line or worse, scratch through, the previous order when there is a change or D/C. Doing so implies that the original order was a mistake, when it fact, it was a valid order that was carried out until the time of the change or D/C.
I agree, it makes the original order appear to be invalid. It also could look like nurses are trying to falsify medical records when viewed from a legal standpoint. I have to say something to some of the nurses who are doing it. I already talked to DON and she thinks it is OK. I have no power over this situation. I have been entering the MD orders for monthly order printouts for 2 months and there have been no errors.
I have to agree that you are in a rough spot if the DON does not see what is wrong with this. Best to approach each individual, one by one, and try to reason with them.
I have not been able to find any professional nursing or medical texts/articles on orders charting. I wonder if there is a standard for orders that I would be able to bring to the nurses as evidence. They don't know me well enough to know my years of experience with hospital and JCAHO orders compliance and some outside documentation would be useful. If anyone has a book or article to recommend I would appreciate it.
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
Twenty years in and out of SNF/LTC in WA & OR and this is how it's done here also with the exception that a single line is drawn through the old order. It's one of the steps in noting the order.
It does make the original order appear invalid from the date of dc.
I have four pillows filled with ruffled feathers! Do what is right...tell whom you need to tell and if it will save a med error or a patient issue, ruffle away!
RNinSoCal
134 Posts
OK, here is what they are doing:
MD order on regular order sheet " 6/15/10 Tylenol 650 mg po q 4 hours prn mild pain Dr. Knowitall" The nurse receives new telephone order from MD on 6/24/10 for Tylenol 325 mg q 4 instead of 650. She goes back to original order on 6/15/10draws a line through and writes changed then writes new/changed order. I do not understand why anyone whould draw a line through an older order on a regular order sheet. The new order is the valid one and the nurse needs to change the MAR not the MD order sheet. This is not just the printed re-cap it is happening on. I know it is bad nursing practice but as a previous poster said feathers will ruffle if I try to tell DON what to do. CHW (former employer) would have had a cow over this kind of nursing practice. I am happily doing MDS forms today.