How would you transcribe this order?

I would DC the biweekly order and write in the 7 day order. Once the 7 days has passed the MD can decide what he wants to do next.

I agree.

Thank you. I also agree but the DON (who obtained and transcribed this order) seems to think that just adding the new order while leaving the old is fine.

The new order supercedes the old.

The new order supercedes the old.

True - but how does the old order get resumed? Just so it's not lost somewhere? A new nurse or agency nurse may not know to know to know to get monitoring OF SOME KIND.

The order could just get lost and the pt would go for who knows HOW LONG without any type of monitoring. There has to be SOME way to see to it that monitoring continues.

Personally, I like the DON's approach the best so far - at least there would be continued observation.

Write the seven day order and rewrite the biweekly order to begin following the stop date of the seven day order

I would not leave the previous order in the MAR as that can cause much room for error as a nurse may not correctly review all medications throughout the MAR (fully) and may administer the weekly medication.

I would write as follows:

D/C current order of Glucosans(ordered dosage) biweekly po (I'm guessing you're refferring to glucosamine)

Begin Glucosans(ordered dosage) BID po x7days then update MD for further instructions-T.O (MD Name)

The MD wants to review after the seven days for a reason; so if you re-instate the old order it may not be what the MD deems therapeutic post seven day administration.

I work second shift and rarely see the staff doctor. I would write the order as written by the physician and ask first shift nursing to get a clarification since this is not a medication order. If it was medication I would be on the phone with the doctor getting a clarification. As a general rule I want to see discontinue orders for treatments or medications.

It caused confusion and she wrote up two nurses who did not see the new order on the very last page of the MAR with the old order on the first page and not dc'd. Her rationale is she assumed they would know the order would just revert back to the old one but the MD was specifically on going to review it in 7 days. She left the orders ambiguous and it caused confusion. I felt if she was going to write the others nurses up then she should also be written up actually.

Treatment, nutritional supplement or medication any change in dosage or frequency should always discontinue the old order. This gets rid of the confusion because, technically, if the old order has not been discontinued then it also needs to be followed. This was one of the biggest causes of med errors I noticed when I was doing LTC consulting.

I agree