Free Reign for Hospice Orders?

[SoCalRN1970]

:twocents:I have worked at a few hospice agencies. Most Medical Directors will allow some basic ok's without orders. For example increasing roxanol from 10 to 20 mg. Inititating atropine etc.

I recently was spoken to because I wrote orders on a Crisis Care patient that was in support of the reason for having staff there 24 hours daily.

I changed orders for Roxanol for pain to same frequency, smaller dosing and specific to respiratory distress. This is what the patient was on for. The PCP knew this pateint was on CC, she gave the ok to go ahead with this. SHe was upset because I tweeked the orders to fit the Respiratory Distress need of the patient's CC diagnosis. ( I did not call her ) I was not initiating new meds. Just different dosing, and purpose. ( patient was comatose and no pain, but respirations were 40-50 a minute! )

I got "spoken" too by my manager. She threatend to write me up. She said I was practicing medication without a license. Ok. I see how this agency plays. I have called the MD for everything I mean everything... Today I was asked. Why are you calling me with all these orders?

Excuse me. Damned if I do, Damned if I don't. I actually told my MD that I was told I had to call for even barrier ointment and app mattresses. So, I suggest she speak to my manager if she feels my calls are too much.

OMG what am I to do?:twocents::twocents: