Give now orders

happytoheal · Sep 19, 2006

In a life-threatening type of situation, my guess would be as soon as possible. Usually if a now order is important (at least where I work) the resident or doctor will verbally tell the nurse that the order is in. For me, if a now order is put in and no one tells me, when I see it, it'll be done. I usually cringe if a now order has been sitting for a couple of hours without being done, but it also depends on what the order is for. Some things don't have to be neccessarily done immediately, just sometime during the shift.

Call me crazy, but I feel that if a doctor thinks an order is important, the nurse should be included in the plan of care. :jester: Although that doesn't always happen, I think the good ones will keep you informed.

Hope this helps!

oneLoneNurse · Sep 19, 2006

I think a NOW order should be given NOW like within at least an hour. HOWEVER, if you have made an assessment and think the patient should NOT RECEIVE the order that is an entirely different issue which in my humble opinion should not be confounded with the way the order for the med was written. To me, we owe it to the patient (and anyone else) to NOT give the med IF we strongly feel as a nurse it should NOT be given.

If you received a "give now" medication order on a patient that was critical ( has already coded a couple of times) and in MSOF. What would be a reasonable and prudent amount of time in which to execute the order? I am not talking about bloods or any infusion that needs special mixing just a regular IV medication.
Thanks

TazziRN, RN · Sep 19, 2006

As soon as possible after the order is taken off. It would take precedence over ordering a diet or lab. If the order is on a pt just transferred to you, it would be asap after the admission assessment.

meownsmile, BSN, RN · Sep 19, 2006

If it is a siutation where the patient isnt immediately in grave danger, our policy states a NOW order has to be given within 1hour of the time it was written.

Larry77, RN · Sep 19, 2006

I work in ED and a "now" or "stat" order is exactly that, it is NOW...not within an hour or half an hour but maybe that's just being in the ED where we are used to getting verbal orders for stat meds.

Is kind of a vague question if you gave us a situation we could probably give you a better answer.

emrrn915 · Sep 19, 2006

If it is a siutation where the patient isnt immediately in grave danger, our policy states a NOW order has to be given within 1hour of the time it was written.

Thank you, that is helpful. So in the case of a pt who is septic and in MSOF with just about everything under the sun going downhill. If an MD orders:

Stop Primaxin Now

Start Vanco now

6 hours later would be considered somewhat negligent?

meownsmile, BSN, RN · Sep 19, 2006

Yep,, i think it would. That would be a case where you would send someone to pharmacy to retrieve the med so it could be given as soon as possible. Occasionally we will get a NOW order that can be retrieved from pyxis, but antibiotics have to come from our pharmacy. We would fax the order to pharmacy and then the ward clerk or someone with a minute would go get it. That would be within the hour, of course with any NOW order you dont really want a delay of much time. A for instance is someone going into respiratory distress from asthma etc. we would retrieve the solumedrol out of the pyxis instead of getting it from pharmacy.

TazziRN, RN · Sep 19, 2006

Thank you, that is helpful. So in the case of a pt who is septic and in MSOF with just about everything under the sun going downhill. If an MD orders:
Stop Primaxin Now
Start Vanco now
6 hours later would be considered somewhat negligent?

Most definitely. In any way, shape, or form.....in any type of situation, 6 hours is nowhere close to "now."

neneRN, BSN, RN · Sep 20, 2006

Our hospital policy states "now" or "stat" orders be completed within 30 minutes.

JentheRN05, RN · Sep 20, 2006

6 Hours??? Ummmm....thats quite irresponsible! Now is NOW - ASAP, not oh - we'll get to it when we got a few extra minutes to go down to pharm to get it. NOW. Geez - numerous times we'd send aides down for a NOW order NOW. Did they have justification for the 6 hours?

GatorRN · Sep 20, 2006

Thank you, that is helpful. So in the case of a pt who is septic and in MSOF with just about everything under the sun going downhill. If an MD orders:
Stop Primaxin Now
Start Vanco now
6 hours later would be considered somewhat negligent?

Somewhat negligent? Ummm, I would say Very Negligent! Especially if the pt is septic and already in MSOF, Vanco were be a very important med to give "Now."