ED admitting orders

[bill4745, RN]

How do other ED's obtain admission orders for patients?

In our ED, the ED doc discusses the patient with the admitting doc and then transfers the call to an RN to take admitting orders. This is a time-consuming, tedious, error-prone task. The admitting docs sometimes speak so rapidly that we can't keep up with them; sometimes they are on a cell phone and it can be difficult to hear them, especially with sound-alike drugs; we often don't have the patient's drug dosages (and sometimes no drug list at all) and they tell us to "write for whatever the family says he's on".

We are often told that verbal orders are to be taken "in an emergency only". Is taking verbal orders to admit a stable pt to med/surg an emergency? Obviously not. How do other hospitals deal with this issue?

[EmerNurse, BSN, RN]

Sorry we do the same thing you do. ED doc presents to the admitting doc on the phone, then turns it over to the RN for getting the telephone admit orders. We're required to do a med recon sheet upon pt. entrance into the ER so we usually have a list, or at least an official "pt. has no idea what meds he's on" on the form.

All in all, our admitting docs are pretty decent and understandable (with one notable miserable exception grrr).

Sure it's prone to mistakes as any telephone orders can be - that's why we read 'em back - ALL of them. They're not allowed to tell us to "keep their home meds". We have to go through each and every one of them on the list and he can say "keep it" or "hold it" and it's written on the recon form, and those kept, are also written on the order form.

Can't really think of a better way it can be done, so long as the ER has to have the admit orders on the chart before the patient can get a bed and go on upstairs.

[CritterLover, BSN, RN]

not how we do it at all.

[color=#483d8b]

[color=#483d8b]er doc talks to the admitting physician by phone, and they decide what orders the patient needs.

[color=#483d8b]

[color=#483d8b]then the er doc writes the admitting orders. all of them. from diet to new treatments to home meds. he charts that he spoke with the attending/admitting physician, and that he is ordering their recomendations.

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[color=#483d8b]this can take a while sometimes, and can be the cause of the dreaded shift-change transfer to the floor (since the doc holds off on writing the admisison orders until he has a minute), but is much better than the above, in my opinion.

[Altra, BSN, RN]

No RN involvement in obtaining orders here ...

If the pt.'s admitting MD has residents, the residents come to the ER, examine the pt. & write the orders. If a pt. is admitted to a "non-teaching" MD, then the ER MDs write temporary admission orders.

[MomNRN, BSN, RN]

not how we do it at all.

[color=#483d8b]

[color=#483d8b]er doc talks to the admitting physician by phone, and they decide what orders the patient needs.

[color=#483d8b]

[color=#483d8b]then the er doc writes the admitting orders. all of them. from diet to new treatments to home meds. he charts that he spoke with the attending/admitting physician, and that he is ordering their recomendations.

[color=#483d8b]

[color=#483d8b]this can take a while sometimes, and can be the cause of the dreaded shift-change transfer to the floor (since the doc holds off on writing the admisison orders until he has a minute), but is much better than the above, in my opinion.

this is how it is done at my facility as well. the accepting floor is also in charge of reconciling meds with the admitting physician.

this system works well for us.

[TazziRN, RN]

ER doc calls the admitting doc. Then either the ER doc writes covering orders-----just enough to get the admitting nurses going in the care until the admit doc gets there or calls, or the admit doc comes in and writes his own.

[ND76]

ER doc calls the admitting doc. Then either the ER doc writes covering orders-----just enough to get the admitting nurses going in the care until the admit doc gets there or calls, or the admit doc comes in and writes his own.

Same at my ER.

Thank god, too. Sometimes I'll take direct admission orders over the phone, and it's a freaking nightmare.

[loricatus]

The ER doc uses a checklist form for interim orders (basics of care plus any meds/fluids) that are valid for only 4 hours. The Admitting Resident is notified and has to be bedside within those 4 hours to assign the patient to a service (surgery, medicine, tele, etc). The resident (or PA) of the assigned service then has to do a bedside assessment to write their H&P within 2 hours of the AR assignment and technically write out admitting orders within that same time frame. After the admission orders are written, the nurses receive the chart back and wait for the bed assignment. Many times the bed assignment can come before the admission orders are received, so we send the patient up with the interim orders and tell the doc to deliver the orders to the floor. The bad part about this is that charts can be missing for hours at a time and a patient who takes a downhill turn while on interim orders is in a limbo state of not having a doctor available to write additional orders (interim orders releases the ER doc from responsibility for the patient, who has yet to be assigned to a service).

[truern]

Beats having a direct admit from a physician's office. We were expecting to receive orders that never came....finally got hold of the MD who said he gave the orders to the patient to bring with her. Okaaaaaay. Go ask the patient AGAIN did the MD give her anything to give to us?!? "Oh, yeah...but the receptionist wrote directions to the hospital on the back and my friend took the paper home with her....and she lives two hours away!!"

Novel idea: FAX ME SOME FREAKING ORDERS!!

:smackingf

[traumaRUs, MSN, APRN]

I worked in big teaching hospital where residents came and saw pts and wrote admitting orders. Much easier.

[nuangel1, BSN, RN]

Sorry we do the same thing you do. ED doc presents to the admitting doc on the phone, then turns it over to the RN for getting the telephone admit orders. We're required to do a med recon sheet upon pt. entrance into the ER so we usually have a list, or at least an official "pt. has no idea what meds he's on" on the form.

All in all, our admitting docs are pretty decent and understandable (with one notable miserable exception grrr).

Sure it's prone to mistakes as any telephone orders can be - that's why we read 'em back - ALL of them. They're not allowed to tell us to "keep their home meds". We have to go through each and every one of them on the list and he can say "keep it" or "hold it" and it's written on the recon form, and those kept, are also written on the order form.

Can't really think of a better way it can be done, so long as the ER has to have the admit orders on the chart before the patient can get a bed and go on upstairs.

we do the same tedious thing and i hate it.

[Spidey's mom, ADN, BSN, RN]

Our ER doc admits either for himself or other docs and then the ER doc writes the orders. We are a rural ER and all the docs know each other well plus most of the patients too.

Sometimes the ER doc will give the patient's doc a heads-up but most of the time docs call in the morning to see if they have had any patients admitted overnight. If so, they come to the hospital to round prior to heading to their clinic.

steph