ED nurses what are your protocols/orders for IV?

Hi, I am an ED RN for 5 years and I work in a small suburban hospital setting. I just wondered what are some of your policy and procedures with regard to starting IV's on pts. ?Is it ok at your discretion if the MD doesn't order it but you feel that the pt "might" need it that you are able to start an IV without a doc's order? Thanks in advance for your responses.

Dog

Technically, if the MD orders lab work with no IV meds, he/she has to put in an order for "IV start" (this is all CPOE). If they order an IV med, I was told that an IV start order does not have to be explicitally ordered...that the IV start is "assumed" with the order for the IV med (of course you know what happnes when you assume ). If the MD just orders labs, I can't think of a situation where they will be upset if an IV is started even if they did not order it in the first place.

We start them, draw labs based on symptoms. No order needed.

Experienced nurses can start them based on experience and we never get in trouble. Last night I had an unconcious mentally retarded seizure patient and I took full advantage of his unconcious state and just started that IV since I knew it would be ordered. Mom said he would be on the attack the minute he woke up.

Mostly it's 'start it if you need it'. Just have to use good judgement. Might I reasonably need a route for fluids or meds? We do have standing order sets for certain patients like CP, stroke, trauma, suspected sepsis, etc. All those are getting IVs in any case.

We start them, draw labs based on symptoms. No order needed.

Do you not get the order after the fact? I'm pretty sure your legally need it...

Our ER docs don't get mad if we do it when they didn't plan on it, but they'll let you know why they wouldn't have and they order it if it's already done to cover us.

We have a very good relationship with our docs, and get to know what they prefer. We have standing orders like other facilities for: chest pain, stroke, nausea/vomitting, fractures, abdominal pain, trauma, things like that. If they don't like it they tell us why and then we don't do it on those types of pt's. In particular we have one doc who does not like IV's on pt's with a migraine unless they've had it greater than 24 hours and have nausea/vomitting.