LTC - What are my actions after receiving phone call regarding new orders?

TheCommuter, BSN, RN · Sep 14, 2011

What are my actions after receiving phone call regarding new orders? I am new and I am afraid to miss something.

1. You read the order(s) back to the doctor on the other end of the phone to ensure that you and him/her are on the same page.

2. You immediately write the order on a telephone order sheet, which can usually be found in the resident's chart. You sign the order like this: T.O.R.B. Dr. Doe/Suzy Q, RN. T.O.R.B. stands for 'telephone order read-back.'

3. You write the order on the resident's M.A.R. (medication administration record) or T.A.R. (treatment administration record) if it involves medication, wound care, tube feedings, nebulizers, or anything that needs to be administered. Make sure the resident has no noted allergies to any of the new meds.

4. If the order is not a medication or treatment (for example: 'obtain xray of left wrist' or 'psychiatry consult'), you would call the imaging company to come out and do a portable xray, or you would call the office of the contracted psychiatrist to make them aware of the consult. If you work nights, you might be able to fax the psychiatrist instead of calling.

5. You notify the resident's family of any new orders. Most are okay with new orders, but some want to know about every little thing, and others will not want any new meds.

6. If the order involves an antibiotic (Levaquin, Amoxicillin, etc.), you must give the initial dose within four hours of receiving the telephone order.

username33 · Sep 14, 2011

That was very helpful! Thank you! I am a brand new RN. What I need to do to protect my license while working in LTC. In other words how can I loose my license?. I am on orientation period and pretty overwhelmed.

I will appreciate your input!:)

SquishyRN, BSN, RN · Sep 14, 2011

To add to what thecommuter said, don't forget to chart in the nurses notes something like "new order for blah blah blah noted and carried out. Responsible party *insert name here* and resident made aware." And to add the new order to any applicable care plans or to the short term care plan.

itthybitthythpider · Sep 15, 2011

Get BPs for residents that have BP meds, whether there are parameters or not. Go slow and be careful not to make an error. Just cause everyone else is fast doesn't mean you should be, too. It'll come to you, but if you stress and try and go too fast, you WILL make an error. Don't document what you didn't do, but document everything you do.

al586 · Sep 15, 2011

In addition to the excellent advice you have received so far, I'd like to add that I make a habit of immediately communicating the telephone order to the pharmacy (we fax the initial order at my facility), if it is appropriate. I also call the pharmacy after faxing the order if I need a med ASAP, and, if need be, obtain the initial dose from the facility supply (we use an Omnicell at my current job; my first facility used an E-box).

Also, when receiving report on a unit that is new to me, I like to find out which residents need accuchecks, have their meds crushed, and so on...it help me to save time during a heavy med pass without taking unsafe shortcuts.

Good Luck!

username33 · Sep 15, 2011

Thank you everyone!!!!

NamasteNurse, BSN, RN · Sep 15, 2011

HELLO!
I am a new grad and started my orientation period in long -term care facility. What are my actions after receiving phone call regarding new orders? I am new and I am afraid to miss something.
Any advice? What are the main points to keep in mind while working in LTC. For example, passing meds, phone orders, labs.......

Excellent advice from previous poster. All the she said, plus at my facility you also write a nurses note, such as " New order obtained for Levaquin 500mg PO BID x 10 days. First dose taken from e-box, administered at 0900. Family aware. "

Another thing I thought of is that you need an order for almost everything, even if it seems silly, like some creams or a UA/C&S. A lot of doctors will tell you to just go ahead and write the order and they will sign it when they come in for routine things like that. Of course you always need an actual T.O. (telephone order) for meds.

Passing meds in LTC is different than at the hospital as well. No one really admits to it, but often enough you do all your AM meds at once. For example, you have meds that are due at 0730, 0900, and 1000. You'd most likely give them all at once. Since most nurses have 20-40 residents, it would be impossible to always be in compliance unless you combine meds like this. Of course narcs are always given exactly on schedule and records must be accurate.

You also will have medicare pay residents who must be charted on every day. The charting must relate to the reason they are there. If you don't chart, it means care wasn't provided and the facility won't get paid for that day.

That's my 2 pennies. have fun!