Taking floor orders in the ED?

[sorefeet]

I was just wondering how many of you have to take admitting orders from the admitting MD (via phone) for the floor and if you do---what is your process.

[Anagray, BSN]

I just started in ED and I completely appreciate how busy it and how difficult it is to have floor orders addressd. Most of the time people go without orders. If attending/designated MDs available they come and write orders downstairs.

on the other hand, as someone who worked med surg it is comepletely unsafe for a patient to come to floor without orders with specific dangerous conditions. Many times I had an acute CVA or GI bleed, abd pain, kidney stones, etc come with no orders and on med surg there are no doctors on stand-by and no standing (regarding pain, distress management) protocols except for BLS. I couldn't even give a duoneb without permission.

I would love to see something change which will benefit everyone.

Nat

[luckylucyrn]

Wow you guys make me appreciate my ED. All that we have to do and then you have to stop what you're doing and take admission orders?!? (OK so this is the only ED I've ever worked in so this concept is foreign to me) What we do is the ED doc calls the prospective admitting doc and they discuss the patient, then the ED doc writes appropriate orders. Sometimes they're more involved than others, depending on whether the admitting doc just wants basic orders done until he or she can see the patient. When the ED doc is done writing the orders, the bed is requested and when assigned, away they go. We are usually able to get order clarifications and whatnot from the ED doc without having to call the admitting doc, unless the admitting doc came to the ED to write the orders personally. This doesn't happen much for me, because I work nights.

[ghostrider]

Do the floors take orders for the ED nurses? Of course not! Why should we take orders for the floor? The floor RN's have questions re: patient orders we have no idea about. The only reason that this is done is that MD's have the idea a RN is an RN so it doesn't matter who takes the orders and they do not want to be bothered to call/transferred to the floor. We put a stop to this by the medical staff office working with the admit MD's and ED MD's and explaining the medical need for physicians to speak with the admit units. This is best for pt care! That was our focus.

[DiannaK]

I work in a stand-alone ER, which is a part of a larger hospital network in the city. We always take admission orders from the admitting MD when we are sending a pt to be admitted. In our ER, the only problem we have is getting to a computer, so that we can review labs/home meds/actions taken in the ER as we talk to the admitting MD.

When I worked in CCU ( a number of years ago, in a different facility), we rarely had admission orders when pts came up from the ER. That always aggravated us, since we felt like we were "under the gun", to get the pt settled, get an assessment and pt history, then call the doctor for orders.

[DiannaK]

I just started in ED and I completely appreciate how busy it and how difficult it is to have floor orders addressd. Most of the time people go without orders. If attending/designated MDs available they come and write orders downstairs.

on the other hand, as someone who worked med surg it is comepletely unsafe for a patient to come to floor without orders with specific dangerous conditions. Many times I had an acute CVA or GI bleed, abd pain, kidney stones, etc come with no orders and on med surg there are no doctors on stand-by and no standing (regarding pain, distress management) protocols except for BLS. I couldn't even give a duoneb without permission.

I would love to see something change which will benefit everyone.

Nat

very well written ... and I think it's difficult to see both sides, unless you've done both. (see my previous post)

[swartzrn]

I work in a military hospital which is also a teaching hospital. All potential admissions are seen by the "medical officer of the day" who is usually a resident and they, in turn, will present that patient's case to the attending. We get an admission card which simply has the patients demographics, diagnosis and to which floor they are being admitted. The resident will put the floor orders in the computer. This system that they use for their orders we don't even have access to in the ED. The floor nurse's won't even take a nursing report from us until the orders are in the computer. Occasionally the resident will ask us to start antibiotics or something like that but they are pretty good about realizing we're usually busy and usually short handed and will leave admission orders to the floor nurses. We do, though, start IV antibiotics for patients who are going to surgery on call to the OR most of the time.

[eborgelt]

We just changed our system recently. Our ER docs Liability Insurance company gave them a deadline to make changes or they would drop them. So here's what we do now:

ER doc calls admitting doc. There are 2 options: Option 1: ER RN can take verbal floor orders from admitting doc. Option 2: ER doc can write very basic orders which are only good for 4 hours. The docs stamp them with a custom stamp we had made that states when they were written, expiration time, and admitting doc to call for further orders. We haven't had had too many issues so far. Most of the admitting docs will just wait for the floor to call them and let our docs write the basic orders for the first 4 hours. The admitting docs that wants to RN to take verbal orders generally are pretty good about knowing what they want. We use basic floor protocol orders depending on admitting diagnosis for most patients. Charge nurse tries to take orders when they don't have an assignment to make it easier on the other nurses.