MD orders, is this normal .......

SouthernLPN2RN, MSN, RN, APRN, NP · May 6, 2006

I'm wondering about that too. We see a few of those types of orders.

burn out · May 6, 2006

Where I work this is a common order esp. for lovenox or heparin or coumadin. Usually the patient has underlying afib and is on an anticoagulate med which has been stopped to prevent bleeding for surgery or procedure. After the procedure the cardiologist will want the drug started as soon as possible but will defer the decision to the surgeon so that from his point of view it is safe and will not start any unnecessary bleeding or problems.

ICURN_NC · May 6, 2006

I haven't seen this- but then again, our docs tend to get consults from that service before changing or going all nuts with meds. It seems it would be the docs responsibility to see if it's "ok" before they right the order. I would hold the med, document that you saw no order from "ortho" or whoever saying whether or not it was ok, and then call the doctor who wrote the order and inform him/her he needs to find out if it's ok before you can give it. Then document that, too.

Sounds like a big mistake waiting to happen. How can you prove it was ok with ortho if they never WRITE it down? Too much grey area for my taste.

Good luck!

snowfreeze, BSN, RN · May 6, 2006

I see this type of order often, the facility I work in has everything on computer. The whole chart is on computer, charting, orders, tests, diagnostics. The doctors respond a bit quicker as most of them also have access from offices and home for the computer chart. When a doc writes an order of this type our Unit clerk will call their office to let them know or the nurse will page them to make them aware. This is very different than what I learned when I started nursing. It seems to work well though.

burn out · May 7, 2006

I haven't seen this- but then again, our docs tend to get consults from that service before changing or going all nuts with meds. It seems it would be the docs responsibility to see if it's "ok" before they right the order. I would hold the med, document that you saw no order from "ortho" or whoever saying whether or not it was ok, and then call the doctor who wrote the order and inform him/her he needs to find out if it's ok before you can give it. Then document that, too.
Sounds like a big mistake waiting to happen. How can you prove it was ok with ortho if they never WRITE it down? Too much grey area for my taste.
Good luck!

What I usually do to make sure there is no mistake is to call the doctor to see if it is ok and then write a telephone order for it to be either started or write to not start the medicine .. it just means that I have to make a phone call.

Tweety, BSN, RN · May 7, 2006

I see it constantly on our patients. Here it's usually ortho wanting to anti-coagulate and writing orders "if o.k. with trauma".

Nothing wrong with respecting the other person. Anti-coagulation is serious busiess, as is not anti-coagulating. The medical team should be in agreement and know what the other guys are doing.

Editorial Team / Admin · May 7, 2006

Totally agree with Tweety. I write similar orders out of courtesy to the consulting physician.

Works2xs · May 7, 2006

Kinda strikes me as an opportunity for an error to be made. Isn't the idea of a consult so that the doctors at least get the opportunity to ask each other questions regarding a particular decision? This seems to allow room for (improper) assumptions to creep in.

rn/writer, RN · May 7, 2006

Isn't this colaborative approach preferable to docs writing orders WITHOUT taking the other discipline's concerns into account? In addition to exposing patients to greater risk, think of all the hassle that could come about when the second physician objects to what the first one has ordered and the nurses find themselves caught in the crossfire. Nothing like watching dueling docs while the patient hangs in limbo or gets whiplash from repeated order changes.

meownsmile, BSN, RN · May 8, 2006

I agree with burnout and others. I work ortho and routinely they are given anticoagulants following arthroplasty and ORIF. Usually the ortho will start and then back down for GP or cardiologist to manage after initial post op day or so. Usually the GP or cardiologist will be following longer than the ortho so they let them manage. A good portion of them have to be cleared medically by GP or cardiologist before surgery anyway.

Also if they routinely back away and let the GP/cardiologist manage those things it is much easiser to decide who to call first if the levels are beyond theraputic. Saves the nurses the headache of calling a doc just to have them say call the other.

Levels are all based on PT/INR anyway, so it doesnt really matter who writes the order.

softstorms · May 8, 2006

Yes you will see a lot of orders like that, and yes, please follow thru and check up with each M.D. We call it CYA. Document each call and the orders given. Sounds like a lot of work, but is best for you in the end.