Does Physician Order Require Hospital Policy?

[mycotton]

If a physician writes an order on a patient's chart, i.e., "Aspiration Precautions", and the hospital does not have a policy for this, what is the nurses obligation for following such precautions? What is the hospital's requirement for having policies in place for all physician orders? I'd appreciate your input.

[UM Review RN, ASN, RN]

As far as I know, if there is no written hospital policy, you'd follow the Standard of Care for nursing for that particular dx and do all the things that nurses would normally be expected to do for that patient.

[TexasGas]

Be proactive. Call the physician, if he is angry about you calling to clarify a situation, document that in your notes. Ifind most physicians are willing to correct mistakes without hesitation, and they would prefer you clear the questions ASAP. He may even appreciate the fact that you brought to his attention that there is no policy.

[elkpark]

If there is no hospital nursing policy/procedure defining "aspiration precautions," I would call the ordered doc and clarify what exactly s/he means by "aspiration precautions" (to make sure we're all singing off the same page in the hymnbook ...), and carry out the order. I would also bring the lack of a policy to the attention of nursing administration.

[AtlantaRN, RN]

if there is no policy, yes call the md for clarification...at my facility, hob elevated 90 degrees when eating and drinking and staff at bedside to observe, or feed patient.

also part of the nursing assessment is assessing patient for aspiration risks

a score > or = 6 = aspiration precations

dependent on others for oral care & feeding = 4

neuro dysfunction = 1

age >65 = 1

GERD or DM= 1

major abd/thoracic surgery and/or immuno suppressed = 1

supine position = 1

NG tube or tube feedings = 1

trach and/or mech ventilation = 1

recent anesthesia = 1

atlantarn

[sirI, MSN, APRN, NP]

if a physician writes an order on a patient's chart, i.e., "aspiration precautions", and the hospital does not have a policy for this, what is the nurses obligation for following such precautions? what is the hospital's requirement for having policies in place for all physician orders? i'd appreciate your input.

if you have any other order that has such broad meaning and you need further clarification, you would call the physician to elaborate i am sure. same thing with this order as well. if this type of thing occurs frequently, the hospital should have policies/procedures written to accomodate the order.

siri, crnp, clnc, rlnc

[purplemania, BSN, RN]

If there is no existing protocol the MD must write orders. There cannot be a protocol for EVERYTHING.