LTC and med orders

[cleo777]

I work in LTC, and I am having difficulty writing requests for medications or treatments. I am told that I can not ask for a medication or a treatment? I am told I have to watch my wording??? And should be writing the request like a doctor order's. I had a pt who had dry and itchy scalp. Faxed Md "pt has dry and itchy scalp" suggestions? MD wrote back " moisturizing shampoo" I had to get it clarified because, it didnt say how often? I was told I should of included that in my first request. I was told I should of written

"pt has dry itichy scalp, suggestions, as PRN? Any suggestions on exactly what is meant by I cannot ask for something???? Confused!!!

[PAERRN20]

Ok I have just gotta say this...I understand that you thought perhaps the MD would give an order for a RX shampoo, but I wouldn't have faxed the MD for that. You don't need an order for a moisturizing shampoo and you certainly don't need an order for frequency of shampooing. Use a conditioner after shampooing the hair.

Critical thinking is a wonderful thing.

Now, in the future, I would write a note to be included in the fax. Any lab results, changes in assessment, etc. You shouldn't name a specific drug or tx in your fax, but I feel it is okay to write "suggestions?" in the note. I've only recently started LTC though.

[lillymom]

I work in a doctors office and when the docs get stuff like this they don't pay that much attention. I'm not sure if this is allowed(since I don't work in LTC) but if so I would state pt has dry itchy skin do you think a prescription would be appropriate? Please advise and give sig. You are not asking for a prescription, you are asking for an opinion. You will more than likely get a more detailed answer otherwise they will tell you something obvious.

[king_of_the_hill_fan]

At my LTC facility, we fax the doctors with order requests if we have a pretty good idea what to ask for. Such as when there's a skin tear or similar, we fax something over like this: "pt. has skin tear measuring x cm by x cm. cleansed w/ns, patted dry, applied triple atb ointment, covered with d/d or steri-strips. may we have this order? please advise, thank you!" Same with certain meds like robitussin or tums or something.

[Over-the-hill-Nurse]

When I fax the doctor I address the Dr. .... (by Name)

State "Resisdent so and so is concerned over her dry and itchy scalp, in appearance, skin looks, dry, with some scaly patches and reddened areas from resident scratching. She would like something for her scalp to resolve this issue. Please inform us of any orders you may deem neccessory to treat it. Thank You D.Carnes, RN

This is how I address any fax sent to the doc. I always state who the resident is, what there complaint is, my assessment of it and request any treatment modality that he might use to treat.

Sometimes they don't want anything, and sometimes they will write orders and fax it back. I do not try to suggest any treatment modality. Some doctors don't like it, and others don't mind. So I prefer to not suggest anything. It is thier job to prescribe any treatment whether it is over the counter such as mositurings shamoo 2 twice weekly or what ever else he/she might want. And also send a cover letter with you fax but whom, and to whom, etc...

[morte, LPN, LVN]

Ok I have just gotta say this...I understand that you thought perhaps the MD would give an order for a RX shampoo, but I wouldn't have faxed the MD for that. You don't need an order for a moisturizing shampoo and you certainly don't need an order for frequency of shampooing. Use a conditioner after shampooing the hair.

Critical thinking is a wonderful thing.

Now, in the future, I would write a note to be included in the fax. Any lab results, changes in assessment, etc. You shouldn't name a specific drug or tx in your fax, but I feel it is okay to write "suggestions?" in the note. I've only recently started LTC though.

No need to be condesending.....in LTC you need an order for about every darn thing. And using a moisturizing shampoo, without consulting the doc, might be construed as practicing medicine w/o a lic.....a determination of causation, perhaps there is more going on than JUST dry skin....

I think the OPs place of employement may be one of those with testy docs whom have to be treated with kid gloves, and don't take suggestion well.

[PAERRN20]

No need to be condesending.....in LTC you need an order for about every darn thing. And using a moisturizing shampoo, without consulting the doc, might be construed as practicing medicine w/o a lic.....a determination of causation, perhaps there is more going on than JUST dry skin....

I think the OPs place of employement may be one of those with testy docs whom have to be treated with kid gloves, and don't take suggestion well.

I know of no state that would say a nurse is practicing medicine without a license by using moisturizing shampoo on a resident. It's not going to harm them. At worst, they may get some greasy hair, and that is not going to do a bit of harm, aside for appearance, especially for a dry scalp. And sure perhaps there is more going on than JUST dry skin, it's a normal part of the aging process though, and moisturizing shampoo is not going to put someone in their grave early or at all.

[systoly]

No need to be condesending.....in LTC you need an order for about every darn thing. And using a moisturizing shampoo, without consulting the doc, might be construed as practicing medicine w/o a lic.....a determination of causation, perhaps there is more going on than JUST dry skin....

I think the OPs place of employement may be one of those with testy docs whom have to be treated with kid gloves, and don't take suggestion well.

Oh come on, your assessment of the situation is based on speculation and anyone who gets offended by the post you call condescending is going to have a hard time in this field.

If you indeed need an order for a particular shampoo, you write the order the way you need it to read (you'll never get it that way from the doc) so he can sign it and fax it right back - mission acomplished

[morte, LPN, LVN]

Oh come on, your assessment of the situation is based on speculation and anyone who gets offended by the post you call condescending is going to have a hard time in this field.

If you indeed need an order for a particular shampoo, you write the order the way you need it to read (you'll never get it that way from the doc) so he can sign it and fax it right back - mission acomplished

I am not having a particularly "hard time" and i found it condesending.....The op is in LTC....this is a whole different kettle of fish than acute care....."diagnosing" the condition as "only" dry skin.....is medicines arena, not nursing....and I think the OPs point was that (s)he is being told to not do what you suggested because the doc is not amenable to that approach.

[systoly]

I am not having a particularly "hard time" and i found it condesending.....The op is in LTC....this is a whole different kettle of fish than acute care....."diagnosing" the condition as "only" dry skin.....is medicines arena, not nursing....and I think the OPs point was that (s)he is being told to not do what you suggested because the doc is not amenable to that approach.

You're having a hard time right now. Just messing with ya. You're right, I read the OP again and I see what you mean. I didn't get that at first. From what I understand now, the OP is supposed to write the order but leave a blank for the particular product. Too much drama over shampoo.

[CoffeeRTC, BSN, RN]

Oye. Did you want something more than Suave moisturizing shampoo like Tgel or something like that? We suggest all kinda of things for our residents and get the orders from our docs. In LTC you are the docs eyes. If you see a problem and know of a potential solution, most docs appriciate suggestions and will order what ever the resident needs/ wants.

As far as getting orders for shampoos.....no, for the most part you really don't need an order for something like suave or xyx brand of shampoo BUT...if it needs to be followed up on and made sure it was done, it is easier to put in on the TAR and have a nurse sign off and check or actually so it...then you need an order for it at our facility. Stupid, yes.

[CapeCodMermaid, RN]

If we didn't suggest things for our residents, we'd never get anything done. I've sent faxes with a cover sheet: Dear Dr Jones..sign the next page...on the next page would be the order I wanted written the correct way. If he signed, great. If he didn't then we'd discuss it. Always have something in mind when you call or fax the doc...Dr Smith, Mrs X has a very congested cough, decreased O2 sats, and noisy lung sounds....how about a chest xray?

Yeah...I thought it was condescending, too.