LPN LTC Horror Story

[elfin1871]

I am a relatively new LPN working in LTC. There are a few problems:

1. No Standing Orders. If it's not on their chart when we get them, it's not an order. We're told "don't call the doctor in the middle of the night to ask for OTC

meds." We're told to write out the order ourselves for OTC meds and the provider will sign them later

[LPN9200]

I suppose that's fairly standard, at least from what I've experienced. It also depends on the doctor/necessity of the order on whether or not we write our own verbals and have them sign later. If it's something that we know a resident needs and the doctor will almost always agree to then we typically do it. But other than that, if it's not urgent, we wait until we can contact the physician themselves.

[TheCommuter, BSN, RN]

I do not see what the horror story is.

When I worked in LTC, never in a million years would I awaken a physician to request an order for Colace or Robitussin. I simply wrote it as a telephone order read-back (T.O.R.B.) and the attending physician always signed it.

[lindseylpn]

Yeah, I don't see "horror story" here either, more like a minor inconvenience. If it's policy to write out an order then that's what I'd do. Some places just don't do standing orders, mine doesn't either and we manage just fine.

[IsabelK]

The facility I'm based at doesn't use standing orders for PRN bowel meds or meds for fever. I don't have a problem with PRN bowel meds (the policy is not to use MOM, thank god). I do want a call for fever. I have written specific orders to cover when to call. Works well, and I can always read the 24 hour report.

[tmaca]

What I'd do is check requirements. Does your state require a DR's order for OTCs for LTC residents? Does your facility have a written policy, like maybe "no meds administered without a DRs order"?

If there's a rule, state or facility, that requires a DR's sign off for OTCs, every time someone administers one without the actual order, relying on a signature from someone later on, he or she is sticking his or her neck out.

The sad reality is that shortcuts being SOP at LTC facilities is more the norm than the exception anymore. It seems like the lowest person on the totem pole is always the one who's asked, whether explicitly or in a "this is how we do it" way, to take chances for the convenience of the more "important" staff, often in ways that leave the DRs and the facility and even the RNs in the clear if anything goes wrong. But if you're a CNA or LPN or such and you make a stink about rule breaking, well, you're a dime a dozen and you better be good at job hunting.