Example is it normal to see medical orders written like the follow....
Start 25 mg. of Lovenox q. day, if o.k. with ortho.
That is just an example, I am seeing more and more orders that are written with the stipulation "if o.k. with ________". I can understand o.k.ing discharge orders with all M.D. involved, but I am having a difficult time understanding why a doctor cannot simply write an order without needing approval from several different sources. Is it all a big game of COVER YOU orifice?
Can someone help me understand? Is this a common practice? Are nurses expected to call several different M.D.s to o.k. orders written by one doctor?
But why must the MD's put the nurse in the middle? Why can't the order be clarified ie a certain INR level or a protocol developed? Why can't the first physician phone the second and get a CLEAR order written? And don't tell me that it is because they are too busy!! Should it not be the responsibility of the order writer to write a clear order no matter WHO thay are?? YIKES!
But why must the MD's put the nurse in the middle? Why can't the order be clarified ie a certain INR level or a protocol developed? Why can't the first physician phone the second and get a CLEAR order written? And don't tell me that it is because they are too busy!! Should it not be the responsibility of the order writer to write a clear order no matter WHO thay are?? YIKES!
:yeahthat:
And then when the second doctor says No - you have to call the first doctor back and let them know. Yesterday I ended up having to call 4 different doctors before I was able to assess all 7 of my patients - because the previous shift was tired of dealing with a situation. Thank God we had good CNAs who had made their rounds, and I knew that all patients were breathing and not in need of anything for pain, etc. Tomorrow will be a better day.
Absolutely it's great to collaborate- but the docs need to do their own work. If it only involves a phone call, let them make the call! If they actually spoke to each other they might learn something from the consult.
And then when the second doctor says No - you have to call the first doctor back and let them know. Yesterday I ended up having to call 4 different doctors.......
A couple of weeks ago, I had an order for discharge for a pt. It read that if is was ok with so and so doctor, then the pt could be d/c'd. WELL the first doctor had told the pt that he could go WITHOUT telling him the conditions of the d/c. So I spent a few hours trying to call the second doctor because the pt was anxious about leaving. The second doctor did not call back for a few hours and then when he did, yelled at me" I don't know why you are calling me. It isn't even my pt!!" and then hung up on me.(OH NO? Then why did you write orders on that pt earlier??) I mean.....REALLY!! Write a clear order or don't write one at all! Lot's of wasted time which as a new nurse is NOT time that I have right now!!!!!!
i have also seen this, and agree it is a mistake waiting to happen. why not just not write the order until they have checked with the other doc? in my experience, these orders were written most often pending morning rounds of the surgeon. i don't feel it's my responsibility to call the surgeon and check to see if it's okay for the order to be put into effect. but, like others, i have done this as a courtesy call. i just think it would be much better if they'd do the consult themselves before writing the order.
I see a lot of orders like that because I work Tele. Most often, our docs will read each other's orders and doc progress notes, so when we're in doubt about what someone's thinking, we go to the progress notes.
We try not to call at 0300 over things like that, especially if the order was written at 2300, but I could easily see the quandary if you got an order like that at 0900. If I worked that shift, I'd probably have to call, but I would HOPE that the doc was basically writing it to legally "remind" the other docs (big CYA), because ultimately, the responsibility to WRITE that order lies with the doc.
Specializes in med/surg, telemetry, IV therapy, mgmt.
This is really nothing more than the doctor shoving off a task that he could do onto the nurse. Ideally, the doctor should call the "other doctor" in the case and discuss whether or not it's OK for him to order whatever it is he wants to order. But, he's in a hurry, so he just writes, "if it's OK with Dr. xyz." That's all it is. The thing is that if the other doctor says it's not OK, then you have to call back the first doctor and give him the news. Now, you're playing a game of "telephone".
This seems like pure laziness to me. Absolutely, the different services should be in agreement on the med regimen, but they need to take responsibility for that themselves, not put the nurse caring for the patient in the position of clarifying whether or not the med orders are OK with everyone.
hey there's an idea!!.thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
Goldenhare
193 Posts
But why must the MD's put the nurse in the middle? Why can't the order be clarified ie a certain INR level or a protocol developed? Why can't the first physician phone the second and get a CLEAR order written? And don't tell me that it is because they are too busy!! Should it not be the responsibility of the order writer to write a clear order no matter WHO thay are?? YIKES!