Last minute orders!

Yes, ward clerks note the time at the bottom when they sign the total orders, this alleviates confusion YET, generally, the charge or nurse over the patient will view the orders before taken off and any stat orders, others that will take time to obtain i.e. giving blood etc. will be given/started and signed off by that nurse sometimes before the ward clerk gets to the chart (or the ward clerk viewing the chart will call the nurse with stat orders even if they can't take the other orders off yet). I haven't seen a definite time or cut-off for orders, after all, the floor works 24hours, on bad days when sometimes just the immediate, stat orders can be done it may take longer then better days. Sometimes the nurse may have just gotten the stat orders and perhaps begun some of the others and will convey that in report, after that it is up to the oncoming nurse/shift to finish.

Seems to me that people forget that nursing is a 24 hour job. 1830 would be the best time to sign off your orders for the 12 hours you worked that is how I have always had my nurses do it. It makes the most sense because you are trying to wrap things up and complete you tasks to be prepared to give an accurate report. Again nursing is a 24 hour job, unless it is stat, and always communicate with your physicians to understand why it is stat, they do tend to wright stat just to make sure its done today and not tommorow.

There is no way to make this at smooth process when physicians have the charts. In our unit there is always a unit secretary at the desk. When they get charts the first thing they do is look for stat and now orders. If there is such an order, they page the nurse. All the nurses carry pagers and are required to hand off that pager to the nurse who takes their place. In any case, the nurse caring for the patient is notified. As for having the chart with you when you give report, this is not going to happen on a routine basis. Either the physicians have the charts or the charge nurse has the chart to sign off the orders. On our unit, the charge nurse sees every order, puts the orders on the MAR and signs off the order. New orders are paged to the nurse.