Last minute orders!

[dnnc52]

Okay just want to find out if there are any good solutions. I work a med-surg flloor and we work the 12hrs shifts. We report to the unit for report at 6:45. This is when we are suppose to give report and then be off the unit on our way at 7:15 (yeah right). The MD make late rounds sometimes and as usual a Doc will pick up a chart, put the time they pick up the chart on the orders then sit down and look at labs and reports, then write the orders. From the MD the orders go to the Unit Clerk. After they take them off they go back in the rack for the nurse to recheck the orders and sign them off. So at what point is the off going nurse responsible for the orders?. If you understand that while we are giving report we are not at that time with the charts. Now one of our managers wants us to give report from the charts but then the doctors or ward clerk have them and it's not been very practical. Unless there are stat orders I suggest that the off going nurse runs their charts at 6:30. Then otherwise its up to the oncoming staff to follow through. This seems to be a on-going problem between some of the shifts. Of course most of this falls on the off going day shift 7P when giving report to the oncoming shift. Also do your ward clerks note the time they take off orders?. So do any of you folks have a resolve or unit protocol covering this situation? Thanks

[Straydandelion]

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.

[cassrn28]

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.

[diane227, LPN, RN]

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.