Doctor's orders drama

[ricaryx]

Okay, I really need a fellow nurses' input on this. I graduated less than a year ago and landed a job at an assisted living firm. We had a new admission the other day who had an order for Senokot 2 tablets. The resident was "somewhat" deteriorating cognitively so the daughter (authorized representative) requested to change the order from Senna 2 tab to 1 tab because the dose is too much for her mom. Whenever there's a new admit, we have to fax the doctor of the current medication orders and permit to admit resident to the facility. So to save me the grief of faxing the doctor twice for the Senokot, I changed the admission orders of 2 tab Senokot to 1 tablet and faxed that to the doctor *to see* if the doctor will sign it. The doctor signed it. I'm supposed to have gotten the order I want. Or am I?

Then the next day, my co-worker freaked out that I shouldn't have done that. She said that I have to fax the doctor separately to change the order for Senokot and get the doctor's signature first before I can have the right to change the admission orders---and get the doctor's signature again. This is after the doctor saw the admission medication orders that I faxed and signed it. I get what my co-worker wanted me to do, and I purposely did not do it, but what's the worst thing that can happen if I skipped a step and ultimately still got the doctor's signature in the end? It seems to have become a big deal to her and I'm just sitting here wondering was it really? I need advice. I asked my DON and she said it should be fine because the doctor signed it, but is there a consensus about this issue that I was in the wrong?

[Kymmi]

Ok...I do not work LTC so I dont know if that makes a difference but my thought is I would have done what you did....why make double work for yourself by faxing one set of orders and then another set of orders. You faxed orders and the physician signed them....he should have read them before he signed them so if he wasnt ok with the orders he should not have signed them. I know people are going to say that the MD's don't always read the orders before they sign them but that's not MY fault....I do not sign my name to anything without reading them first.

I might have a different viewpoint if you told me you changed a insulin dose or a cardiac med but to change a stool softner from 2 to 1 a day is not going to have a fatal impact on the patient. I still stand by the fact the MD should read it before he signs it but I guess I would just take more precaution if the med was a med that effects a major system however bottom line is if he signed it then you've got your orders legally.