legal or not?

[LPNWCC]

Hi! I'm relatively new to this site and have recently encountered a issue at the home health agency I work for. They require a RN counter signature to all orders written by LPNs. Company practice. However; the clerical staff who sends the orders out often forget to get the counter signature before they get the MD's signature. If this happens, the order gets signed by an RN after the MD places his/her signature. So, my question -- is this legal by Medicare guidelines to have the RN sign after the MD signed?

[SuesquatchRN, BSN, RN]

I have no idea. Why does it matter, though?

[Pinkster]

I don't know anything about the legality, nor could we discuss it here right?

But I don't see why it would matter who signs it first, as long as it is correct and approved

[UM Review RN, ASN, RN]

Hi! I'm relatively new to this site and have recently encountered a issue at the home health agency I work for. They require a RN counter signature to all orders written by LPNs. Company practice. However; the clerical staff who sends the orders out often forget to get the counter signature before they get the MD's signature. If this happens, the order gets signed by an RN after the MD places his/her signature. So, my question -- is this legal by Medicare guidelines to have the RN sign after the MD signed?

I don't know if it's legal, but I would feel safer countersigning an MD order after it was signed by the MD rather than before.

[lpnflorida]

Isn't this nurse simply refering to signing off an order? Yes, RN's sign off on all orders no matter where you are working. It should be signed off before the end of shift. Ideally .Whether or not the doctor has already signed the order is not the issue. If the doctor themselves write the order an RN is still signing off the order on the order sheet.

[jbtampa]

we all see things every day that are troublesome. for me, I use my own assessment for all such things and go forward with best practice for my patient. sometimes we can only go forward for the day. I sure would not gum up care with paper problems. I am also a respiratory therapist, though, and we often write orders for later md signature, so that is sending my thinking to clinical outcome, not nursing diagnoses, which is hogwash much of the time.