Do you need an order for this???

[flashpoint]

Yesterday, I took a phone call from one of the nurses in a local LTC. She said that the day before, a UA had been ordered on a resident. The UA was collected and sent to the hospital lab, where is was accidently left sitting on a counter over night. She called wanting an order to collect another UA. The doctor I was working for was just swamped and this is the sort of thing that his nurses have been given the authority to OK without checking with him...it is part of our list of standing orders. So...I told her to go ahead and collect the UA and send it to lab. She asked me if I needed to check with the doctor and I told her that I had the OK from him already. Well...she obviously didn't like my answer and called the office manager to complain. My doctor is backing me 100%, but it just irks me that she feels like I overstepped my bounds and had to get the office manager and the supervisor at the nursing home involved. It's not like I am ordering meds or anything...I said it was OK to re-collect an improperly stored specimen...when I worked in LTC, I would have just done it, since essentially, the first order wasn't carried out anyway.

We have a list of standing orders that we can OK without talking to the providers...UAs if the patient is symptomatic, Tylenol or Motrin for age and weight, Dulcolax suppositories, BUN and creatanine before contrast CTs, pregnancy tests before x-rays in women of child bearing age...things like that, so I was in no way out of line...at least I don't think I was.

[meownsmile, BSN, RN]

I dont think so.. If the UA wasnt completed as ordered then of course they should have just gone ahead and recollected. Shouldnt have been any reason to bother you with that.

As far as the other things,, standing orders are ok if you are a office nurse Tylenol, specimen collections. But that has to be weighted very carefully due to allergies and certain medication contraindications. To just be given authority to order because it is on a standing order can be touchy where meds are concerned.

You werent out of line at all. The LTC needs to review their policy and make sure everyone is on the same page including the doctors.

[CoffeeRTC, BSN, RN]

Um..I would have just wrote the order myself and wouldn't have bothered the doc. Some docs give us that leeway too.

Maybe what the nurse was getting riled up with is that many times I'll get a call back from the docs office for a med change,order,etc and will get it from the docs nurse. Of course we all know we aren't suposed to take these orders, but come on....it was a UA!!

BTW in LTC you need an order to sneeze! LOL.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Wow. Our docs would get pizzed if we called them to order a UA. Just write it and they will sign it if it is something so harmless. I write the order and collect them all the time by myself. Never had a problem. I think the doc would be mad if I noticed foul smelling cloudy urine and DIDN'T do one. Besides, you already had the order! The doc would probably be confused, thinking... "Didn't I already order one? Why do we need a repeat?"

[grimmy, RN]

wow. our docs would get pizzed if we called them to order a ua. just write it and they will sign it if it is something so harmless. i write the order and collect them all the time by myself. never had a problem. i think the doc would be mad if i noticed foul smelling cloudy urine and didn't do one. besides, you already had the order! the doc would probably be confused, thinking... "didn't i already order one? why do we need a repeat?"

i would think this would qualify as a verbal order. goodness knows that i run them through the or constantly. yes, eventually that md has to sign off within a certain time for the orders, but a ua seems to be a petty issue.

[Noryn]

There shoudnt have even been a call unless it was to notify the doctor what had happened with the UA. If you have an order for a UA then if something happens to the specimen you don't need another order. That to me is the same as if you are taking a medication to a patient, you drop it then discard it. Then of course you get another pill, you dont call the doctor for another order.

I know it is frustrating but I wouldnt worry too much about it. The doctor is backing you, you had standing orders, and really this is foolish. Most nurses just collect UAs then notify the doctor when they come in along with the symptoms.

[Antikigirl, ASN, RN]

I think I can shed some light on this that would help you all understand...

LTC's and ALF's have so many rules about things it isn't funny! I worked in an ALF for 3+ years and I felt like I needed an order to wipe a patient!!! I even..get this, had to get orders for a bandaid!!!!!!! Oh yeah, what a thrill to call or fax a busy MD for that!!!

The deal with the UA isn't just the LTC, it is also the Lab. We had to get signed MD orders to get the UA and the reason for it (and no, lab would not accept 'confusion' either which many of the times is the reason we collected one!). So it wasn't the LTC as much as the lab paperwork that had to be completed in order for a pick up...does that make sense??? It was a pain in the keester!

Us nurses were like "heck we can get an order for this" and would fax (and we didn't care if the order didn't come back for a while...we knew it would be okay)...but if the fax didn't come back in time, lab wouldn't accept the UA (has also to do with charges for the patient as well...they wouldn't take any samples without assurance that it would be covered by insurance).

The whole bandaid stuff stems from lawsuits, and the fact that to be safe, you have to have an order for EVERYTHING...cause Lord forbid someone may get a skin reaction from the adhesive and sue the LTC! I couldn't even put a telfa on a patient till orders came in...but I could use gauze??? Uhgggggg! (also had to do with charges...patients will be charged for telfa or bandaids, so in order to have it covered by medicare/medicaid...MD order was vital....).

Yeah, I felt the whole thing took away everything professional about a nurse! The autonomy to choose simple treatments without having to bother the MD right then and there! Glad I work in the hospital again where I have that liberty back (and standing orders!!!).

I asked about standing orders for pts in LTC..and I was told that all standing orders would have to be renewed every three months by the MD anyway...so best to just get an order by fax and save the MD time that way...uhgggggggggggggg!!!!!!!!!

[Antikigirl, ASN, RN]

Oh by the way...I started to get smart about all those nonsense calls to MD's and had the 90 day orders printed out with: "simple dressing changes per RN discression". And "UA's with culture/sensitivity if indicated by RN" and my favorite because we also couldn't D/C ANYTHING without an order..."may D/C by nurse discression" on all woundcare treatments so the patient wasn't charged for a healed wound three months later because an MD didn't D/C the treatment (with duoderms, that got spendy fast for the patients, and pharmacy would send the duoderms and refuse to D/C without MD order!!!).

[PamUK]

I'm reading this & thinking "the NHS isn't so bad after all!" No wories about asking the doctor to order a Bandaid... he would look at us as if we had lost the plot! We order blood tests (FBC U&E, blood, urinalysis ... I assume that is a UA) & tell the doctor when the results come back, if they are abnormal. Wouldn't give a nanosecond of a thought to ask the doctor.

[zacarias, ASN, RN]

I would write the order as "UA per standing orders" if the UA is truly part of standing orders.