Does facility policy supercede any physcian order? If so, are physcians orders needed

I don't have any great answer. I have found policy and procedure manuals seldom give very specific guidelines, they are intentionally vague. Our "routine" has varied from seldom using them, to every patient gets them, to every surgery over 1 hour gets them. And some doctors want them on every patient regardless of length of surgery.

It can be annoying to work in vague gray areas, however I can't see how it could be a problem??? Are you concerned a patient would be harmed by TED's? Or are you concerned a patient would be harmed by not having them on and developing a clot?

My OR is big on using SCDs on all patients. In the few years that I've worked there, our policy is that we don't need a physician's order in order to use them, although 99% of surgeons do have them ordered. It just covers the occasional missed order, basically.

To brownbook: Here is the deal.... I do not have a problem with putting them on everyody that needs them, or according to our assessment tool, needs them. My problem is, according to our assessment tool, not everybody needs them. For example if the surgery is less than 45 mins even if they meet the standards, they do not need them. Like our number is 2. If the pt has a 2 according to the assesment tool, then they meet requirements. That is if they are walking through our doors, so to speak they need them. But if the surgery is less than 45 mins and they still have a 2, they should not need them. I was verbally written up for not appling them to a pt with that same senario. I was told I was not following policy and I could be fired. I was also told that they are keeping a tab on all the preop nurses od who is not being compliant with the VTE procedures so they could report back to corporate and possibly be fired. The assessment tool specifically states" VTE ordered" and I" have ordered the apprioate VTE for this pt" and requests a physcians signature. I am the only one signing this, no physcian is signing this nor am I getting a order for this. I have been told that no physcians order is needed, however this is not presented in the policy that managemnt says it is. I do not have a problem with providing safety measures to prevent clots by any means. But dont threaten my job because I am following the assesment tool that they created, and a policy which is not clear. I am at a loss as to how to handle this. Nursing has become so politcal and corporate based, I love caring for the pts, its all the BS that is hard to deal with. It also is not just me, its all the preop staff they are doing this to. HELP!

Where you are working sounds terrible!!!!! Sorry, I don't have great answers. Sounds like you need to eat crow so to speak even though you are following the policy. Or else they will fire you!!! Terrible situation.

If (that is a big IF) someone in management would be agreeable to listening to you in a non threatening manner. If you could politely say you are confused by the TED policy. Ask if you and your fellow nurses could form a committee to review the policy and come up with a policy that is easier to work with, easier to understand? Of course you would probably have to do it on your own time, I doubt they would pay you to do it!!!!

As I said you will probably have to "make nice" even though it sounds like where you work they don't or won't make nice back!!!

If you want I could find our policy and give it to you. Honestly I have never even read ours!!!!!

Yea that sounds great, check out your policy and shoot it to me. I am not in a good situation, however, I guess if I want to continue working there, I do need to eat crow. Been thinking alot about this, and I am just gonna put them on everybody, who is a general case. I'm not fighting this fight. I do feel as though I am my own advocate, not even our nurse manager is our advocate. Thanks for your input!

our policy states any patient who is having *general * anesthetic gets scd's we only use the boots, no teds.

I asked our manager where I would find our policy on SCD's, or TED's. Ha, Ha, she laughed and said we don't even have one!!!! However she made a note to herself that she need's to get us one since it is a doctor order. At least our management people laugh about it, don't threaten to fire people!!!!!