Ever do something before MD order?

renerian, BSN, RN · Nov 22, 2003

If it is an emergency I go right away, otherwise I call first just to CYA.

renerian

Speculating · Nov 22, 2003

Originally posted by wenron
Say you want to make an extra skilled visit, get a UA, check o2 sat, check a BG, ect. and didn't call the Doc for a verbal order. We send out a fax, (unless we need to speak to them right now) but don't always get it back in time (signed) before we are performing the procedure. How do you all cover yourselves?

I've absolutely ordered things in the past before getting an MD's. orders to do so. You must, however, follow-up rather quickly by getting the formal orders. In your brief scenario I would need more patient information before order that much, but that's me. There are many factors involved before hanging yourself out there on a limb. Like, what's the patient's hx, and what kind of distress are in at the moment? What's the problem at hand is it an MI or a UTI? Very important, who's the patient's primary care physician or who's the primary care physician on call for that patient is it Dr. Jekyll or Dr. Hyde? What is it you're ordering, and what's the ticket price? I would order a chest x-ray without hesitation but never a CT scan. I would never order medications other than a respiratory treatment. In everything I've written about so far it's been about an acute episode with a patient. You can't go around doing these things willy-nilly, and you have to have a solid rapport with the physician who's going to okay it after the fact. Remember, to only toss this stuff around on rare occasion when your patient can't wait for the doctor to get there and neither can you as you hover over a near code situation! It certainly doesn't need to be said that on rare occasion you've done this or you've done that it will come around some day and kick you in the %*#% I promise you. Take Care of Yourself, renerian

LilgirlRN, ADN, RN · Nov 22, 2003

hmmmm.... Mr. Smith sure does look blue, nailbeds are dusky, I can hear him breathing from 15 feet away. Let me call Dr Jones so I can do an O2 sat? By the time the doc calls back the patient could be dead and when he calls and I tell him what's going on he's gonna ask me "what's his O2 sat?" I do things all the time to save time and it make come back and bite me on the butt but it hasn't yet.

wenron · Nov 22, 2003

I didn't mean all of those things at once. But say you need an extra skilled nurve visit for a ct. Would you call on a Saturday and ask to speak with the Doctor? It seems so silly. Or, you want to put PT in or MSW, would the doctor want to be bothered for something like that?

wenron · Nov 22, 2003

Originally posted by LilgirlRN
hmmmm.... Mr. Smith sure does look blue, nailbeds are dusky, I can hear him breathing from 15 feet away. Let me call Dr Jones so I can do an O2 sat? By the time the doc calls back the patient could be dead and when he calls and I tell him what's going on he's gonna ask me "what's his O2 sat?" I do things all the time to save time and it make come back and bite me on the butt but it hasn't yet.

Oh, I agree totally. I have only been in HH a couple of years and we would just fax an order with the things we wanted on it such as those I mentioned. But, now, we have to call for everything and get a verbal. Why don't they have standard orders for BG, 02 Sats, extra snv, etc?

renerian, BSN, RN · Nov 22, 2003

We have no standing orders. I would call 911 if someone was home and blue LOL. I just have had Docs refuse to sign for things before so I am more cautious. Plus our agency was once sued for doing that as the doc said nurses were practicing medicine.

renerian:eek:

Speculating · Nov 23, 2003

Originally posted by wenron
I didn't mean all of those things at once. But say you need an extra skilled nurve visit for a ct. Would you call on a Saturday and ask to speak with the Doctor? It seems so silly. Or, you want to put PT in or MSW, would the doctor want to be bothered for something like that?

Wenron,

Not calling the MD to schedule an extra shift that by the way would benefit you could get you in some seriously deep @#*^ guaranteed. Not to mention the extra shift would cost upwards of $300.00. On top of that you have the salaries of PT and MSW which would run another approximately $200.00 a shift each. That's about $700.00 you just spent. Thinking about calling yet!

wenron · Nov 23, 2003

Originally posted by Speculating
Wenron,
Not calling the MD to schedule an extra shift that by the way would benefit you could get you in some seriously deep @#*^ guaranteed. Not to mention the extra shift would cost upwards of $300.00. On top of that you have the salaries of PT and MSW which would run another approximately $200.00 a shift each. That's about $700.00 you just spent. Thinking about calling yet!

Gosh, our Docs get mad when you call with UA results on the weekend and I just can't see this "Yes, can I make an extra skilled nurse visit tomm because we need to discuss med mgmt" but I am learning a lot still.:)

hoolahan, ASN, RN · Nov 23, 2003

On weekdays, I will call the doc, but weekends, I just write the verbals. The ONLY time I will not do something w/o having doc's OK, even if family insists, is a Hospice referral, I got seriously burned twice. Family wanted it, seemed totally appropriate, doc hit the roof and said pt wasn't terminal, she was 100 years old for Christmas sakes!!!!!!!!! She just wanted to die at home. I was more upset that it got the poor pt so upset. It was a really ugly situation, and it could have been completely avoided had I just called the doc first. It was on a weekday too. School of hard knocks.

But, when I open a case, I order all that stuff, like pulse ox prn anyway, so if you follow me, you are covered. But like Lilgirl said, doc is only going to ask you for pulse ox. My agency doesn't have pulse ox's anymore, so it isn't even an issue. We feel pt's and doc's use that as an out for a pt to get attn for a serious problem. WE would just as soon have them go to ER if they have SOB, covers our butts all the way around.