Need another MD order?

[Iris123]

As a Hospice Nurse at time of admission most times a Hospice "medication kit" is ordered which contains frequently used meds for Hospice patients. I was told that although an MD signs an order for those meds to be sent to the patient's home and all meds within the kit are labeled with directions, you have to call the MD for an order prior to using the Hospice "medication kit" medications for another order? Why, rational? He has signed an order for the meds already?

[leslie :-D]

a medication kit is usually a standing order.

but as you know, it is comprised of sev'l different meds.

the doc could lose his license, if the nurse decided to use haldol for pain.:)

just look at it as an official way of authorizing and documenting what you are giving, why and for whom.

otherwise, the contents of the med kit, could be dangerously misused.

leslie

[Iris123]

Thanks Leslie for the info!

[caliotter3]

I would look at it this way. The standing order is to get the kit into the house at the start, sort of a "provide the supply" order. The second order is the specific order for the way in which the doctor wants you to administer the "supply" according to your rendition to him/her of the patient's condition at the time.

[NurseLoveJoy88, ASN, RN]

i have a question. what if the pt. have a comfort pack but no orders??? do we need an order now or just before any of the meds is used?

[sharpeimom]

the second order is to prevent the type of mistake that was made when my mom was dying and a hospice patient. she had breast ca with mets to her liver, pancreas and brain and because of her altered mental state,frequently became hysterical if i came near her or tried to care for her. she was at home and we filled in the gaps with 24 hour nurses and an occasional aide with the hospice nurse visiting regularly. we had the box of hospice meds and instructions to call the doctor before giving certain of the meds.

by then, she wouldn't take anything i gave her so meds administration was up the nurse.

this system worked until the last week when increasing amounts of morphine, and haldol were needed.

also in her regular meds box was halcion. i discovered three days later that the day nurse had been going into the hospice meds box and slipping my mom extra morphine along with haldol because she didn't want to have to deal with a difficult and paranoid patient every shift. to make things worse, she had been giving her halcion instead of haldol three times a day. she no longer has a nursing license.

extreme, but it does happen. orders are necessary. in my mom's case, it would not have kept her alive longer, but she probably would not have been as paranoid, confused or combative had her meds been given with on the spot orders.

kathy

shar pei mom:paw::paw: