How do you know when to get an order?

ArmaniX, MSN, APRN · Dec 23, 2015

When you need something.. that is when you call for the order.

I routinely will put in restraint orders without phoning the physician. I'll let them know later but I am not calling an ICU doctor to ask for a restraint. In the morning if my icu patient does not have any orders for labs or a chest x-ray, i will put the orders in for them. What I do is wrong though, you should always call and get an order when needed.

I have also had a physician tell me to put whatever orders I want under his name, to do what I needed so long as I don't kill the patient. In court that would never stand and I would be in major trouble.

Know what you are doing and the implications of such. I take verbal orders and document the conversation each and every time. There are some things I refuse to put the order in and require the physician to do it, such as orders for blood transfusions or heparin drips.

Dogen · Dec 23, 2015

My unit has certain standing orders that we can initiate on our own under specific circumstances, like Benadryl for itching, etc. If I assess my patient to have a need that can only be met via a prescription then I call. 9 times out of 10 that means they need a medication, usually for sleep, anxiety, BP, etc.

I only take verbal orders if the provider isn't on the premises, but that's our policy (which is convenient for me). If the prescriber is in the hospital it's their job to put the order in, barring an emergency. If they're not in the hospital I take the verbal order. I've never had a problem with this, but I can appreciate the hesitation. You should read back and verify, question orders that sound odd ("did you say diphenhydramine or carbamazepine?"), and use SBAR so that hopefully they get enough information to prevent things from going south. :)

This is also a good reason to stay on top of your charting. If you get a verbal at 1930, chart it then, and pt crashes at 2230 that's a stronger case that things went the way you charted than charting at 0630 when you may be viewed as just doing some CYA. Not that it matters... generally speaking if it's your word against a physician administration will side with the physician unless there's evidence of flagrant malpractice.

oldsockventriloquist · Dec 23, 2015

When you need something.. that is when you call for the order.
I routinely will put in restraint orders without phoning the physician. I'll let them know later but I am not calling an ICU doctor to ask for a restraint. In the morning if my icu patient does not have any orders for labs or a chest x-ray, i will put the orders in for them. What I do is wrong though, you should always call and get an order when needed.
I have also had a physician tell me to put whatever orders I want under his name, to do what I needed so long as I don't kill the patient. In court that would never stand and I would be in major trouble.
Know what you are doing and the implications of such. I take verbal orders and document the conversation each and every time. There are some things I refuse to put the order in and require the physician to do it, such as orders for blood transfusions or heparin drips.

So most of the time, when there is no status change, you don't call. If there is something you need from the unit supply (non-pharmacy) AND it does not effect the status of the patient in any potentially dangerous way, you don't call. For everything else, you call. Also, for standing orders, who informs you of stuff you can give PRN?

Been there,done that, ASN, RN · Dec 23, 2015

Jumping the gun, you are. ..get through nursing school. Get back to us.

Susie2310 · Dec 23, 2015

From the OP's earlier posts it appears he/she is considering becoming a nursing student. OP, please could you clarify why you asked this question in your OP.

ScrappytheCoco · Dec 23, 2015

At many of the hospitals I have worked in, the physicians have access which enables them to place electronic orders from home. You can politely ask them

to do this and avoid the drama of a misunderstood verbal order or potential "he said/she said" physician/nurse conflict.

loriangel14, RN · Dec 23, 2015

If you need something for the patient and there is no order that's when you have to call for an order. An order can be verbal, telephone or written.

sailornurse · Dec 23, 2015

From the OP's earlier posts it appears he/she is considering becoming a nursing student. OP, please could you clarify why you asked this question in your OP.

Then she needs to change her username, OP you can not use a title not earned -BSN.

About bstobsn

You can add: to be or 2B to username.

MunoRN, RN · Dec 23, 2015

Then she needs to change her username, OP you can not use a title not earned -BSN.
About bstobsn
You can add: to be or 2B to username.

The username bstobsn would seem to refer to someone with a BS who is planning on or is actively pursuing a BSN, so I don't think the name makes any claim that the person currently has a BSN.

akulahawkRN, ADN, RN, EMT-P · Dec 23, 2015

I have always wondered when there is a physician on-call, what autonomy do you have in your unit and when must you get permission for something? My next question is, do you trust verbal orders or do things need to phoned in or written before you'll give it? Meaning if things go south, what's to stop a physician from saying that she/he never called about the order?

There are quite a few variables in play for what you're asking about. Some, probably most, floors and patient care units have standing orders or protocols that are able to be activated by the nurse upon seeing the need for whatever that protocol covers. Those are essentially pre-approved and you'd enter the order as "per protocol" and you're good to go. If it's not something you can do independently within your given scope of practice, and it's not covered by protocol, you probably have to obtain an order for it.

Generally speaking, in my department, while I do take verbal orders and can enter them on behalf of a physician, the physician can usually enter their orders about as quickly as I can... so most of the time they'll do it before I have to, if they've given me a verbal order. Occasionally if the physician is knee-deep in something, they'll give me a verbal order and I'll just put it in for them.

One other big thing to know is that some physicians don't like having others enter verbal orders for them... so you do have to get to know which physicians trust YOU enough to enter the order appropriately and which ones prefer to do the order entries themselves.

Fear not, you'll learn this stuff as you progress through school (they usually won't allow you to directly take verbal orders/do order entries) and begin orienting when you get a job, any job. This is because many places do things just a bit differently so you'll just have to learn the way "they" do it.

applesxoranges, BSN, RN · Dec 23, 2015

When someone orders something without an order from a physician, they risk getting in trouble. Now, there is some gray area with nursing protocol orders such as the nurse will be required to remove a foley on day whatever unless an order.

In the ER, we have a lot of gray area at my current job. We have protocol orders the physicians will flip if you do not use. A lot of gray area. If you do not put blood work orders in the computer, some will get annoyed. There is a lot of gray area. The protocols involve a lot of orders.