epic nursing communications vs epic orders

[Lvuv]

I am interested to hear any stories about providers placing an epic nursing communication for something that should be a nursing order. Like a pts TPN. Does institutional policy trump a provider nursing communication?

What was the order? How did you handle it?

Thanks!

[MunoRN, RN]

What was the specific communication?

[Lvuv]

Okay to hang pt home TPN. no other orders no mar order Pharmacy was not involved even.

[MunoRN, RN]

I'd write that as an order then. If meds can only be entered through CPOE then I'd tell the doc to put it in as an order.

[Here.I.Stand, BSN, RN]

Something involving TPN really should be a provider order. I mean, TPN is critical enough to need two nurses checking the orders against the pharmacy label...so I would not be at all comfortable just hanging the pt's home TPN with no order.

We use the nurse communication feature for things like "No info given except to mom. Password is Supercalifragilisticexpialidocious." Most of our nursing orders are consults to the WOCN for new skin breakdown, or to the IV team RN for difficult sticks.

[Karou]

I would call pharmacy and notify them of the order, then ask them their advice. Really we usually have a nutritionist and pharmacy decide TPN mixtures and infusion rates. If it's day time, can you call the physician to clarify?

I had a physician put in for a blood transfusion in a "communication order". I was really upset. Day shift never saw it, although they acknowledged it electronically, and remembered the physician mentioning transfusing a unit. I ended up putting in the order in myself correctly after verifying with my charge nurse that that was the right thing to do. I think we did it as a secondary order and I referenced the communication order in the comment section.

I'm that case I was irritated with the RN for not "noticing" the 15:00 order, but more annoyed with the physician who actually knows better and should have put it in correctly.

I've also seen "start home meds", "consult so and so", and other misplaced orders. I hate the start home meds one because I feel the physician should do that. Maybe he didn't look over their list well and I start them all, and the physician blames me? No I call him instead and list them all.

[dudette10, MSN, RN]

That happens most to us when the new interns come in. They can't find the real order, so they put it in as a nursing communication. We call them back and tell them to put it in correctly because no other department will get the order.