EKG

It's not an invasive procedure....however EKGs generally do require MD orders at some point. Is it difficult to obtain an order after the fact? Can you get a standing MD order per protocol for chest pain or SOB as determined by the RN?

We usually get EKGs when indicated, call MD with results, and then get an order at that time. Most of our MDs would rather be called with "Mr such and such is having chest pain here's what the EKG says" rather than waiting for them to call back and doing nothing with a patient having an apparent issue.

This works well for us. As always, follow facility policy and what works in your place of work.

In critical care we can order EKGs, labs and chest/ABD xrays per protocol.

In a prison environment with many patients having extensive drug (resulting in cardiac issues) and psych issues (QT/QTc elongation) I feel protocol EKGs are important.

If a patient is having chest pain , tachy or Brady cardiac or SOB , I automatically do an EKG. 9,times out of ten the doc will order one anyway.

hi, i work in a less than progressive prison environment in california, i also have 25 yrs of er expierence. my current employer says a rn is acting outside his/her scope by obtainin an ekg w/o a md order. i cannot believe this, anyone know what the nursing care act says. thanks, Bob RN

Poppycock.

I don't know what the nurse care act says. Actually, I don't even know what it is.

But- I am skeptical that obtaining a 12 lead is out of the scope of practice for a nurse. How is it different than cardiac monitoring? Nobody would ever claim that a 5 electrode monitor needs an order. And, with a 5 electrode monitor, I can easily look at all 12 leads. In fact, I can add a module and simultaneously monitor all 12 leads. then do a printout.

I would suggest asking the manager which part of obtaining a 12 lead is out of scope?

• Putting on electrodes
  
• Hooking up wires
  
• pressing print
  

Do they consider basic cardiac monitoring an action needing an order? If not, are there particular leads they don't want you peeking at?

I bet you it has more to do with the expense of the test than it does the actual action, our world today...

The problem us an MD needs to read the EKG since you cannot always trust the computer interpretation!

I work a telemetry floor and we are required to get an order prior to an EKG. That being said, I have never had a doctor refuse to OK the order after I obtained the EKG.

I think the main reason getting an order is important is so the patient will be charged for the ekg. I have no idea about the scope of practice thing, but I'm willing to bet that any place that needs nurses to work there has some sort of ekg protocol in place.

An EKG is a procedure. You need an order for any procedures/tests/meds given. In my unit, we have a standing order for EKGs due to chest pain/sob/arrythmias, etc. However, we still have to release the order so it can be officially interpreted, billed, and put in the chart. Everything you do in the hospital has to have an order- even tele monitoring. It's not just as simple as putting the leads on and pushing the start button.

An EKG is a procedure. You need an order for any procedures/tests/meds given. In my unit, we have a standing order for EKGs due to chest pain/sob/arrythmias, etc. However, we still have to release the order so it can be officially interpreted, billed, and put in the chart. Everything you do in the hospital has to have an order- even tele monitoring. It's not just as simple as putting the leads on and pushing the start button.

It sounds more like a protocol thing then a scope of practice issue.

In ER around the country, people are put on cardiac monitoring with no standing order. Applying a cardiac monitor is within nursing independent scope of practice. How is the act of getting an EKG different?

I get that there are protocols, billing issues, etc...

That does not put it out of the scope of practice for a nurse.

In my opinion, yes getting an EKG does require an order. Most places have protocols to get an EKG in certain circumstances and the protocol provides the standing order for you. Getting an EKG needs an order because someone needs to interpret the results of the test. Its like getting a CXR or an ECHO. You dont need an order because its gonna hurt the patients, you need an order because you cant just do tests that nobody is going to interpret the results for. To do it (officially) just based on nursing judgement would indeed require a broader scope of practice, at least in places that I have worked. Silly or not.