ECG require MD order?

[alle0400]

Good morning,

The hospital that I currently work at requires a MD order every time a RN requests an ECG (usually for chest pain or arrhythmia found on a 5-lead). I'd like to change that. I'm wondering what are the experiences of nurses at other hospitals. Do your 12-lead ECGs require an MD order? Do you have a standing PRN order for ECGs? Nurse protocol order for ECGs? I'm gathering evidence so if you would be so kind, please let me know what your requirements are for an ECG and which hospital.

Thanks so much!

Dani, RN

[cleback]

We have a standing order as part of a chest pain protocol. Sometimes I get the impression from the doctors that they wouldn't have ordered the ekg, but I suppose they put up with it for the times it may actually be a cardiac event.

[Okami_CCRN, BSN, RN]

Our facility requires a physician order for an EKG, to further reinforce this our EKG machines are set up that the you cannot perform an EKG without selective the patient from the database of ordered EKG's. The reason why went to this system was that many nurses were performing EKG's without orders and the hospital was not able to charge the patients appropriately, it also falls into a legality limbo.

[AceOfHearts<3]

We don't need an order at my hospital from the provider, or at least on my unit. We put it in as a nursing referral or per protocol. I'm on a tele unit, so many patients have conditional EKG orders that can be released, but I have no problem putting in a single order when needed. We like to do the EKG before calling the doctor. I did just that the other day when a patient on the 5-lead tele was sinus rhythm in the AM and I noticed he became sinus arrthymia. We'll do it to confirm new afib, when pt complains of new onset CP, etc. I did one once to confirm a prolonged QT on a post-surgical pt prescribed zofran- called the doc to let them know what was going on (pt had cardiac issues during an ortho surgery which is why they came to my unit) and asked for an order for something besides zofran. Our docs are always happy we do them before calling since it saves time.

Our machines, like another poster's, do require an order be put in or released by the nurse before the EKG can be completed. We can't just do one without it being in the system, but nurses are allowed to order them when necessary.

My manager does say we have much more autonomy than nurses at other facilities, but we just don't realize it since most of us have never worked anywhere else and because we are so used to it.

[canoehead, BSN, RN]

We can do/order an EKG at nursing discretion. That's been true of the last four hospitals I've worked at. Its a noninvasive test, so you cant do any harm. If the physician didn't want the EKG ordered, we can throw out that piece of paper. The catch was that if we ordered and did an EKG we needed to have a provider review it (pretty reasonable). The potential lawsuit for not doing an EKG will cost more money than losing a charge.