Direct Admissions without doctor orders

[General E. Speaking, RN]

Do you ever get direct admissions to your unit without any orders? Has happened to me and I feel this is a huge liability. I mean if they are on my floor in a room aren't I responsible for them? But technically can't touch them because I don't have orders (IV start for emergency)? How ridiculous is it to have to stop what i am doing to call the doctor for orders?

Many times we get patients from Cath Lab that were classified as "outpt" so if we aren't careful and check to see that their status has been changed to "inpt or OBS" when they get to the floor we cannot get any meds out of Pyxis, put in any orders because they don't exist.

Have spoken w/ mgmt. It doesn't occur regularly but still rears its ugly head now and then..

[General E. Speaking, RN, RN]

Thanks so much for everyones input. I am really peeved about this. I am mad at the situation but also I am flabbergasted that everyone involved doesn't think of this as a HUGE liability/safety issue like I do.

Actually, it happened again yesterday when I was off. A patient came from another hospital in a rural area via EMS. They bypass the ER and get directly admitted to a room- a direct admit. The other charge nurse told me about it today. I confronted the house sup who had arranged and accepted the patient and she became very flustered saying the this particular MD "always does this". My response was that just because a MD "always does this" and we do not have a bad outcome and we eventually get what we need doesn't make it right or safe. It should be addressed!!

I was so busy today- 10 admits. We were full (24 bed unit) and discharged then immediately readmitted to capacity so I totally forgot to follow up and do an incident report- not that this is helping. I am making a mental note to discuss w/ Risk mgmt.

What about the comment I had from my coordinator to not get so worried because I don't have orders yet? Meaning (I guess) that I am not responsible. She says it is just like an admitted patient waiting in the lobby for their room to be ready. They are ADMITTED to my facility and on my unit in a room as a patient. Aren't we responsible for their safety?

[diane227, LPN, RN]

We get them and usually the orders have been faxed over to admitting but they cannot find them. So I just call the doctor and get new orders. Or even before the patient arrives, the doctor will call me and give me orders over the phone. It is usually not a big problem for us.

[General E. Speaking, RN, RN]

We get them and usually the orders have been faxed over to admitting but they cannot find them. So I just call the doctor and get new orders. Or even before the patient arrives, the doctor will call me and give me orders over the phone. It is usually not a big problem for us.

I am happy it is not a big deal for your unit. I have, however, had pt sit in a room for almost an hour waiting for orders. Spoke with the Risk Mgmt Dept about this.

[HappydayRn]

Crazy thing happened to us, ER admit. Some how there was some mix up as to who the admitting team was. When i called the "supposed" admit doc he denied admittng the pt. Took about an hour to get orders including meals and pain meds for the poor pt. The house sup was all over it though.

[lvICU]

We used to have this problem but the hospital has changed things around and it is no longer an issue. However, when we were getting direct admits, the patients often arrived with an order sheet in hand. Sometimes I would call the MD office for verbal orders. If we had to wait, we would do some vitals hook up the tele and start the admission database, do an assessment, etc. Unless the patient is unstable an IV can wait if you feel uncomfortable doing that without an order. The patient knows they are being admitted and the above treatments are the standard of care.