Drug level standing orders

Nurses General Nursing

Published

Starting January 1, 2017 there is a standing order for new admissions to our inpatient psych unit. To paraphrase, the order basically states if a pt. is admitted and is on Depakote, Tegretol or Lithium, the nurse is to enter a lab draw to test the drug level the following morning. That is all it states. There was an instance where a pt was admitted and lithium level was done in ED. Physician reviewed the level and did not order anything further. The next day an email was sent out to nurses stating it was the nurses responsibility to enter another lithium level for the next morning. Many of us nurses do not feel it was our responsibility because it was technically a recheck level. Our nurse manager seems to be on the side of the physician and states he's being "very understanding" about the situation. It actually makes me quite angry, because I do not feel comfortable taking it upon myself to order lab work with such a vague standing order. In my eyes, if he wanted a repeat level he should have ordered it when he gave admission orders. I feel a standing order should be more precise or it is encouraging nurses to work beyond their scope. I envision a multitude of possible factors where the doctor could say "Why did you order that?" Thoughts?

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