Doctor's Orders

[SchoolNurseK, BSN, RN]

Anyone else spending significant amounts of time trying to get doctors to clarify their orders? I can't understand why they wouldn't include the most basic components of a medication order such as FREQUENCY, DOSE, ROUTE. Basic stuff! Ugh...just complaining...

My favorite is when you finally get the order and it just says "Take as directed"

[BrisketRN, BSN, RN]

I usually get at least one "All OTC meds per bottle" order per year.

Or my favorite is despite our med form stating we need a physician's orders for ALL MEDICATION INCLUDING PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS. Then the parent writes "N/A OTC Med" in the physician signature line.

52 minutes ago, BiscuitRN said:

"N/A OTC Med" in the physician signature line.

Haha, totally! My daughter is in 6th grade and her entire grade is heading down to the Cape for three nights and four days in May (G_d bless those chaperones). We had a big meeting about it last week and were given forms that have to be completed and returned by March 1st. One section is medical stuff and there is a medical form that has an area where parents need to have a MD signature for ALL medications. There is even a little box you can check that says "I understand if my MD does NOT sign this form, my child will NOT receive ANY medications, including OTC medications". It goes on to give examples of OTC medications. They went through a lengthy oral explanation at the meeting about why they need the MD signature for ANY medication. Wouldn't you know at the end of the night during Q&A, a parent raises her hand and says "But you only need to have this form signed if your kid need a daily Rx medication, correct"?

[SchoolNurseK, BSN, RN]

9 minutes ago, MHDNURSE said:

Wouldn't you know at the end of the night during Q&A, a parent raises her hand and says "But you only need to have this form signed if your kid need a daily Rx medication, correct"?

I.Cannot.Even. ?

[kidzcare]

11 minutes ago, MHDNURSE said:

Haha, totally! My daughter is in 6th grade and her entire grade is heading down to the Cape for three nights and four days in May (G_d bless those chaperones). We had a big meeting about it last week and were given forms that have to be completed and returned by March 1st. One section is medical stuff and there is a medical form that has an area where parents need to have a MD signature for ALL medications. There is even a little box you can check that says "I understand if my MD does NOT sign this form, my child will NOT receive ANY medications, including OTC medications". It goes on to give examples of OTC medications. They went through a lengthy oral explanation at the meeting about why they need the MD signature for ANY medication. Wouldn't you know at the end of the night during Q&A, a parent raises her hand and says "But you only need to have this form signed if your kid need a daily Rx medication, correct"?

It is exactly the same at camp every year.

I have kids that attend the camp too. I KNOW that there are at least 4 places you have to check or initial that say "No medications can be brought to camp with your child. All medications, including OTC medications, must be ordered through the camp's pharmacy" (There are also a ton of stock OTC meds that we keep in the health center that the parents sign off on for their child to have).

Still, every year, kids show up with their prescription medication bottles, dayquil to use PRN, vitamins, ibuprofen, etc. It is so frustrating. And most of the campers arrive on buses so their parents aren't there to send the medication home with.

[SchoolNurseK, BSN, RN]

I can give SOME grace to parents on this one. I think they figure they don't have to have an order to give their kid the med, so why should we? BUT DOCTORS??? No. They know we need orders! They would never do this if they were ordering Tylenol for an inpatient....at least I hope they wouldn't!

[ruby_jane, BSN, RN]

I have found that most times (when I press the button on the phone tree that says I'm a doctor or hospital) that I generally get results in 48 hours. I can think of three times in 10 years that the doctor(s) were not responsive. I put it back on the parent.... as in: I cannot administer the medication, per district policy, without X, Y, and Z. You are welcome to come and administer it while we're waiting for clarification.

Of course on a rescue med...that goes out the window...

[mainecoonRN92, BSN, RN]

33 minutes ago, ruby_jane said:

I put it back on the parent.... as in: I cannot administer the medication, per district policy, without X, Y, and Z. You are welcome to come and administer it while we're waiting for clarification.

^^^^ This! I do not accept orders that do not have all the information. It is stated in our medication policy, our parent handbook, and parents are presented the requirements during beginning of the year conferences.

I am not going to lull parents into a false sense of security of me accepting the orders, or medications heaven forbid, without the proper documentation. It's a slippery slope of "well you have the medication in your office, why can't you just give it?" Lord knows in an emergency, I would give a child their rescue medication without orders, but with me being in a pre-k, we could lose our licensing for even having the medications in our building without proper doctors orders.

[amoLucia]

7 hours ago, SchoolNurseK said:

I can give SOME grace to parents on this one. I think they figure they don't have to have an order to give their kid the med, so why should we? BUT DOCTORS??? No. They know we need orders! They would never do this if they were ordering Tylenol for an inpatient....at least I hope they wouldn't!

Any chance that an MA or receptionist may be the one sending off the 'script? They just might NOT KNOW TO KNOW how to compose a correct 'script.

MHDNURSE - wanna' bet that parent was texting or on her iPAD when that part of the lecture was discussed!?!

Another 'hats off' to you SNs.

[Flare, ASN, BSN]

i really like the idea of check off boxes for all of the nuances of the order sheet. I have an "initial here" to confirm you have read the policy, but I think that may be better.

[SchoolNurseK, BSN, RN]

11 hours ago, amoLucia said:

Any chance that an MA or receptionist may be the one sending off the 'script? They just might NOT KNOW TO KNOW how to compose a correct 'script.

That could be the case. I do feel that if the doctor gives them that responsibility, they should be instructed on the required components of a medication order. It creates so much work and risk for those of us that are supposed to follow the order. ?