Do you need a MD order for IS?

lisamc1RN, LPN · Jul 19, 2009

I don't know if it's NEEDED, and it doesn't make sense to me that it would have to be an oder, but I would get one anyway. It's the best way to make sure there is follow through with all the nurses who will be caring for the resident.

RedCell · Jul 19, 2009

Okay...dumb question:
If a person has come from having pneumonia and atelectasis (in hospital) to your facility (rehab), and they have an IS from the hospital, do you need an MD order for them to continue to use the IS? Are you only allowed to have them cough and deep breath w/out the MD order for the IS? Thanks!

In the states of North Dakota and Alaska you do not need an order or so I have been told (Cannot vouch for the other 48 states though). We just pick from one of many awe inspiring nursing diagnosis' to cover this type of problem. How about impaired respiratory exchange due to poor protoplasm. Now that is an outstanding nursing dx that you can utilize to justify and implement the use of an incentive spirometer.

If that is not good enough, just go with common sense.

If you are still worried, wait until around 0300, and then call the attending physician to discuss the current dilemma and possibly obtain an official order.

mommiof2kids · Jul 19, 2009

I don't know if you technically need an order or not. However, I would CYA myself and get one anyway

allnurses Guide · Jul 20, 2009

It really just depends usually, on the policy at your particular facility and/or the laws put down by the BON in your state.

Personally, I've given people IS's to use before without an order, if it's 1 AM and I feel like they would benefit from one. However, this is not something I would particularly recommend that you do; again, see above. Plus, like someone said above, having an official order in the chart helps guarantee follow through from the nurses and RT's.

CraigB-RN, MSN, RN · Jul 20, 2009

In order to code it right to get the most reimbursment, you should have a doctors order. In some places Resp Therapy starts and they can bill for it. Coughing and deep breathing on the other hard are triied and true nursing skills.

SlightlyMental_RN · Jul 20, 2009

Thanks everyone! That's what I thought, but I wanted to make sure. You guys rock! :bow:

wooh, BSN, RN · Jul 20, 2009

Why the concern for needing to CYA? What's going to happen if you let a person use their IS without a MD order? Oh my goodness! They might get air into their lungs! Wouldn't want to be called into court for having your patient breathe!!

Even the billing issue, while I could see in some cases it being pertinent, y'all didn't actually initiate the IS. You're just letting and encouraging the patient to continue using it. Didn't even spend the time teaching it or supply the actual piece of plastic to the patient.

diane227, LPN, RN · Jul 20, 2009

I just order it if I think they need it.

ChristyRN2009 · Jul 20, 2009

We have them on our floor so I just give it to the patient if I think they need it. I can't think of a possible adverse reaction to using one...

lisamc1RN, LPN · Jul 20, 2009

Why the concern for needing to CYA? What's going to happen if you let a person use their IS without a MD order? Oh my goodness! They might get air into their lungs! Wouldn't want to be called into court for having your patient breathe!!
Even the billing issue, while I could see in some cases it being pertinent, y'all didn't actually initiate the IS. You're just letting and encouraging the patient to continue using it. Didn't even spend the time teaching it or supply the actual piece of plastic to the patient.

It's not about encouraging the resident to use it. It's about making sure there is continuity with those taking care of him/her. Especially when said resident may be very sick, very tired, maybe even have dementia. Sitting the IS by the bedside may not be enough. IS are not something I see daily on my unit, so I want to make sure all of the nurses are on the same page in regards to care.

NC Girl BSN · Jul 20, 2009

I work on a neuro floor and its a standing order for all our post ops.