Discharge Order Help

lilbiskit78 · Oct 12, 2005

At my hospital, they usually write "continue home meds" and then if they are starting any new home meds the doc will leave a script for the new med on the chart. Sometimes they don't write anything.......LOL.......they write, "D/C home" and nothing about the home meds. If I know the pt is going home I try to look at what the Dr wrote before he/she leaves the floor so I can ask questions if need be. Also, sometimes I look at the physician's progress notes and see if they want them to continue home meds, but I still end up paging them overhead to get the actual order. I am a new RN and still get confused sometimes on the d/c orders, but overall that's how it's done where I work.

Lil

Thunderwolf, MSN, RN · Oct 13, 2005

Per our hospital policy, regardless if the doc writes "D/C home" or whatever beyond that, the nurses hand write ALL meds on the discharge sheet that the patient is to resume at home after discharge. This is also reviewed with the patient and/or family. What meds are to be started the next day and what med doses yet need to be taken for that day are discussed. Pt/family is also hand given the prescriptions at that time. I also document on the discharge sheet what prescriptions were hand given to them. The patient signs the sheet and is then given a copy.

sweetielin · Dec 14, 2005

our doc write continue home meds. sometimes they do this on admit orders, too, leaving us with the work of finding and writing them all out.

Tweety, BSN, RN · Dec 14, 2005

I see both. Most of the time, it's cointue home meds with maybe an exception or a new script added on.

HappyNurse2005, RN · Dec 15, 2005

Not all write "contine home meds". ONe PA, and one doc that I can think of will write out "resume following home medications" and list them. Many just include new rx's.

WE have to write out all meds on a form. There are places for med/purpose/amount/frequency/special instructions but I try to write in "took once today" in teh special instructions section, or "do not take tylenol while taking this med" (for lortab, or such), or like yesterday "do not smoke while on nictotine patch"

Though, we've jsut started a new national patient safety goals, which includes a sheet, a medication reconciliation form, that means we list all the meds on admission. the doc marks yes or no if he wants them to continue the meds while hospitalized, then at d/c marks yes or no if he wants htem to continue them at home, too. It just started, on my unit, with new admissions on monday, but i didn't have any new admit patients, so i've not had an oppotunity to try it out yet.

Daytonite, BSN, RN · Dec 15, 2005

Our physicians have a special form for the discharge medications that they are supposed to list all the medications they want the patient taking at discharge. It is a two part form. One stays with the chart. The patient copy is actually a prescription for them to take to their pharmacist to have the meds filled.

We nurses still have a discharge summary form we must fill out. On it is a section where we have to list the discharge meds as well as activity and diet orders and follow up visits with their doctor.

Kansas_RN · Dec 16, 2005

If the doctor writes continue home meds..that is what I write on the discharge instructions. How many times have you seen that the patient's home list is different than the H&P, and they are both different that the PCP office list. Sorry, I am NOT going to write it down wrong and get in trouble for prescribing without an order. If the docs want it written out then they write it out or write "continue current meds" or "home meds listed on H&P". I want documentation that I am writing what the doctor has ordered....not trying to guess what the patient is on or what the doctor thinks the patient is taking at home.

Besides have you seen some of the home lists from the elderly patients? Crossed out meds, "Now I take a half a pill of that one" Who knows if it is the same dose or not.

I have had a patient tell me that that lasix 40 she has listed isn't right. She only takes half a pill. After looking at her BOX OF PILLS she happened to bring with her the Lasix is actually and 80mg tab, but half a pill. H-E-L-L-O same dose....See what I mean?

CYOB - Cover Your Own But!!!! Learn it! Live it!!!

starcandy · Dec 16, 2005

We are not allowed to discharge pts with "resume home meds". The Dr. has to write out every medication the patient is on including new prescriptions. This is a strict policy where I work.

dian57 · Dec 16, 2005

I think a "Continue Home Meds" order can be dangerous and leave the doc open to problems with misunderstandings, especially in my geriatric setting. Maybe it's okay for younger hospital patients with short stays.

I'm in LTC facility and we (nurses) present the discharging doc with the current MAR and TAR. He/She then writes a prescription for each med that should be taken once the patient is home. If the resident is transferring to an Adult Home setting, they have to write scripts for OTCs, too.

We legibly write the list of meds/treatments on the discharge form according to the paper scripts. If the patient is going home alone and I know they have visual problems, I make them a large-font list of their meds to post on their fridge, along with the times they have been receiving the meds while in our facility.

We also make a copy of all the scripts now because of an ugly situation that occurred awhile back. The copy goes in the closed chart along with the Home Care Referral and signed discharge instructions copy.

It's a lot of work, but better to prevent a misunderstanding and med error once the patient is home.

meownsmile, BSN, RN · Dec 16, 2005

We have a list that the dr is to initial next to any med he wants the patient to continue. We are NOT to take "continue home med" orders of any kind nor are we to accept "resume med" orders following surgery. We call the doctor and will read the list to him/her and they have to verbally acknowledge that they want that particular medication and dosage resumed or continued following discharge. Pain in the backside sure,, but it doesnt take to long for them to get the hint and they do it before they leave in the first place. They have a problem and they can take it up with the facility,, they write the policy we nurses dont.

Kansas_RN · Dec 16, 2005

It is a policy where I am from too. But in a small hospital with doctors that have been there 25 years, or Ortho staff with "g*d complexes" good luck. Management says to the floor nurses, "page them until they clarify", but when a doc gets ticked off and starts to hang up on the nurses that is going to affect the working relationship. If management wants it rectified then THEY need to continue addressing it with the docs.

Just my two cents.