Getting new orders

[krg8089]

My question is about how to go about new orders. I just started my first nursing job in a LTC facility. I graduated a couple months ago. I feel like the paperwork is the hardest part in these first few days! We didn't do any orders or dealing with doctors in nursing school. So when do we need a script from the doctor? When we fax the doctor about needing a specific med/upping a dose and him faxing back with an "ok" do we need a script or just write a telephone order and fax that to pharmacy? When we have a script do we also need to write up a telephone order to send a copy to pharmacy and medical records? Thank you in advance for any help or advice! :)

[CapeCodMermaid, RN]

You need both a script and a telephone order for any narcotic. For a non-narcotic, you simply need an MD order.

If you're still using paper MARa, you'll have to fax any new orders to the pharmacy regardless of the kind of order it is.

[amoLucia]

Just a word of advice - always, always. always make sure that you have an order to cover any of your med/treatment orders. Some places have standing orders for certain situations, but rule of thumb is that if you do it, better have an order for it. And anything faxed, to or from, make sure you keep the copy.

Suggestion - ask your Staff Development nurse for a quick, specific inservice. Your Unit Mgr or supervisor could also be utilized. Or an experienced co-worker or staff from another shift may be able to help. I've done Inservice/SD so newbies tend to gravitate to me for help so I work with them when/where I can.

[BrandonLPN, LPN]

I'm confused about needier a script for narcotics? I've never done that, always just write any med order, narc or otherwise, as a telephone order. Of course, we have an in house pharmacy, so maybe that's different?

[amoLucia]

It's a hard-copy script (signed and with a DEA #) that's needed by pharmacy to cover your big narcs. Our contracted pharm wouldn't even SMELL an order unless we had hard-copy for our Class IIs; they would short-term cover our Class IIIs until we had signed telephone scripts. Made a big horrific nightmare with late admissions needing pain med as they rolled in.

That's how it was at my last place.

[CapeCodMermaid, RN]

Narcotic ordering, documenting, and dispensing are all regulated by the Feds. They have been enforcing some laws now they use to not bother with....like narcotic scripts.

[BrandonLPN, LPN]

Narcotic ordering, documenting, and dispensing are all regulated by the Feds. They have been enforcing some laws now they use to not bother with....like narcotic scripts.

But does it make a difference if we have an in-house pharmacy? The doctor writes and signs the order, we give the carbon to our pharmacy and they give us the narcs. I've never heard of needing a "script" where I work.

[MichelleRN34, ADN, RN]

But does it make a difference if we have an in-house pharmacy? The doctor writes and signs the order, we give the carbon to our pharmacy and they give us the narcs. I've never heard of needing a "script" where I work.

I pretty sure all narcs need a hard copy on file. Any where I've ever worked we could write the orders but the next time the doctor was there he or she had to write a hard copy of the script which was faxed to the pharmacy then placed in the chart.

[BrandonLPN, LPN]

Hmm, maybe our pharmacy handles all this on their end where I work. I've never seen a script. Sounds like a pain in the butt for nursing to have to handle all that.

[Vinniesguy]

It was a bit of a chore in the last place where I worked. The doctor would tell us over the phone that they wanted to chart something. We would then have to fax a blank med page which s/he would fill in and fax back. Then we would have to fax it to the pharmacy who would then call the doctor to get a script sent over!

[NutmeggeRN, BSN]

We get TO's for new meds or changes in sig, fax that to pharm. For narcs the MD faxes either us or the pharmacy the written Rx.