Admit Orders in the ER

[Toquay]

Just curious how many hospitals out there make their ER nurses take the admission orders? If you do take the admission orders, how do you and your co-workers feel about it?

I have only worked in one ER (nights) for the past 11 yrs and we are to cater to the admitting docs, which can be quite frustrating... hangs ups if you can't get to the phone fast enough, angry and demeaning if they have a foreign accent and you ask them to repeat an order, as well as being angry that its 3am and we woke them up, oftentimes 3-4 pages of orders with them asking for most the orders to be carried out in the ER (so they know its done), and the worst being they call in the 3-4 pages of orders on their cell phone only to walk in the ER 10 minutes later or even be in house (usually this happens before 11pm). To top it off we have to fill out a form showing any delay in the patient getting to the floor once orders are recieved. Since we all know its the ER nurse that causes the delay.... NOT lol.

Toq

[bill4745, RN]

We take verbal admitting orders and it is constantly discussed and debated. Between the noisy environment, doctor's cell phones unclear, accents, a zilllion different drugs, etc. errors are bound to happen. I keep raising the issue of "verbal orders only in an emergency". Is admitting a stable pneumonia pt an emergency?

A related gripe of mine is when an admitting doc sees a pt in the ER, writes stat orders, puts the chart in the rack but doesn't tell anyone about the stat orders.

[mmutk, BSN, RN, EMT-I]

We take brief admission orders here too, but most doctors keep it fairly short and end it with...

-Call M.D. upon arrival to floor.

[MAISY, RN-ER, BSN, RN]

We must have admission orders to our observation units: abdominal, cp, and tia observation. Other areas do not require orders, although it is considered good practice to provide them.

Generally, if a patient is being admitted through our ER they have received every test required for their condition. Our admitting physicians don't need to give us pages of orders.

As far as, rudeness or accents. If I don't understand a physician and he gives me attitude, I make him spell everything or tell him to call me when he has good service. I will not guess! I have to sign those orders. If he hangs up, I will keep ordering calls-we are computerized and each call shows up on his record. I also note in chart. No one does that to me twice!

Maisy;)

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

I'm fortunate that I've only worked in a rural ER and the ER doc writes the orders for admits and then the patient's doc comes in first thing in the morning to round. Our docs take turns as the ER doc and they have an agreement not to call each other at night. We also use the ER doc if we need to contact a doc about an admitted patient. We don't call docs at home.

Usually we get the IV antibiotics and pain relief on the ER orders and start that all there.

We also have pre-printed orders for MI, Pneumonia, etc.

We are highly discouraged from taking verbal orders unless it is an emergency and especially in the ER taking a verbal order when the doc is standing right there. Most of the docs are very good about that except one, who shouts orders from the bedside. We take him the chart.

I'll be moving to a larger city ER soon so I'll have to see how it is done there.

steph

[nuangel1, BSN, RN]

in my er we only have to get admitting orders if the pt is an eu hold .ie pt is staying in er because there is no floor bed .at that point the pt is officially admitted and we have to get orders and do the admit floor nsg assessment .pain in the you know what.otherwise if pt is seen by admitting md in er md writes his orders.if not pt is sent to floor without orders and floor nurse has to call for them.if admitting md orders a test or med stat we will give it .other wise we don't even look at admit orders.

[jojotoo, RN]

We are required to take admit orders, and we hate it!

[Zookeeper3]

Our facility does not allow patients to be transfered to any area without admit orders. The primary nurse, or really any nurse can take the telephone orders. Then if there is no bed, the ER nurse has to transcribe an MAR on paper and carry out all ordered labs and meds until transfer. If it is more than two hours, the ER nurse has to initiate the admission packet... yep, the phonebook... holding patients is an initial hell, then a blessing once their settled, hate to transfer them once you are done.

[edprincess]

At my first job, I had to take telephone orders and hated it. The docs always seem to call at the worst time, get mad when you don't jump to the phone and say, "yes doctor, ok doctor, not a problem doctor". It stunk! And then to call them back because whichever med is non formulary at the pharmacy...YUCK.

The ER I currenty work in has house physicians who come and see the pt's in the ER and then follow their care upstairs. It alleviates cellphone cut outs and taking up your precious time. The down fall is 1. It's not computerize so you still have to interpret his/her handwriting 2. waiting for the physician to come down and see the pt. Since the house MD's stay in the hospital it's great except when they're busy on the floor with a nurse/patient and you're waiting for orders. The patient has a bed and it's clean, just need orders. In this case, most ER attendings will write "interum orders". The floors nurses hate it but it covers our butts and helps decompress the ER.

If only we were allowed to make the rules...this is the computer age and I still have to decipher a doc's handwriting. UGH!

[Dragonnurse1, ASN, RN]

We had to take orders for certain MD's but I kept them short and sweet.

Admit to

Dx

IV

Meds

ADLs

Meals.

that was it. We had one er Doc that we all could write his orders and just have him sign them.

If a MD got abrasive with me about a pt (on phone) my standard response was: Are you going to come in or do you want ER Doc to see or give me orders so the idiot can go upstairs and you can see them in the morning. After a short silence they picked one of the three and I was done. I never had a problem with taking orders just getting admit orders from the residents.:angryfire:angryfire

[oldiebutgoodie, RN]

I had a doc with a heavy accent tell me I needed to get my ears cleaned out because I kept asking him to repeat the orders.

Oldiebutgoodie