Need resource for MD orders guidelines please

[RNinSoCal]

Hello educators,

I have run into a problem with nurses crossing out MD orders that have been changed or discontinued at a LTC facility.

For example an order written on the MD order sheet reads "6/15/10 Tylenol 650 mg po Q 6 hours prn for mild pain Dr. Knowitall" If the MD writes new order "6/25/10 DC previous Tylenol order. Tylenol 325 mg po Q 6 hours prn for mild pain Dr. Knowitall" the nurses are crossing out the order on 6/15/10 on the MD order sheet and writing DC'd next to it.

I hope that was a clear example. I tried to tell the DON that the order on the MAR needs to be crossed out and re-written but never the order on the MD order sheet. She thinks that this practice is OK.

I have been looking for some kind of book or article that would give concrete proof that this is poor nursing practice so that I can pass it along to the DON. Does anyone have a resource or reference that I could use to help improve the nurses practice with MD orders?

Thanks in advance for any assistance.

[kids]

It has been the policy in ever SNF/LTC that I have worked for 20 years that the dc'd order is crossed off the Physician's Order's page (I'm assuming you mean the computer generated POs that come out every month) with 'dc' and the date written in and the nurse's signature.

It's the responsibility of the nurse noting the new order to update the printed orders, it's considered one of steps in noting the new order.

I don't see how it's poor nursing practice to update the physicians orders.

[RNinSoCal]

You are misunderstanding. They are doing this on the regular order pages outside of the monthly printed orders forms-on the hand written daily order sheets. The regular MD order sheets look like a confused mess with orders crossed out everywhere. I have never seen anything like it. If it was just correcting the monthly orders I wouldn't be asking this question.