New LPN confused about alot, help!!!!

NC Girl BSN · Jan 19, 2008

ok---this is the deal---i got my first true job in a long term care facility in new york (been in orientation for 1week). i'm scared that i may fall by the wayside so i am reaching out to you wonderful people for help.
1. i am highly confused about medication transcription. i know a little, i have transcribed a med or 2 from an interim order form with the help of my instructor--that i kinda get. but when do you call a patient's family member? do you call when the doctor order a new med or treatment, do you call if the resident has a new wound, or does it depend on whether or not the resident can make the decision (and how will i know or where will i look in the chart to see that it is enough to just notify the resident)?
2. i was orienting today so i saw a lpn transcribing doctors order from what she said was the monthly dr order sheet to the mar (but it's not the end of the month i thought). so my question is, are the monthly order sheets only used at the end of the month when the doctors come to the nurses station or are they also used when a new resident is admitted?
3. from my understanding, from the little snippits that was shared with me today (after i pried). a resident when admitted sees the doctor first (correct me if i am right or wrong), where he/she is given a list of the patient med either from their doctor or orally (how am i doing???) then the nursing home dr fills out his monthly order form (so where does the medication reconciliation form come from??) and send it to the pharmacy 1st (am i right???)
this is where the plot thickens---> so how does it go from being a doctor order to the typed mar???
once the mar is typed and the end of the next month comes each doctor comes on different days with their neatly typed monthly orders to the nursing station (right so far???) so before he got to the floor he didn't give a copy to pharmacy,right???
the doctor comes to the floor and writes the order. its the responsibility of the nurse to sign off the order,etc. fax it to the pharmacy and put it on the mar, or write up lab slip, so the nurse transcribe the new orders to the mar
(like i saw the girl at work doing) and cross out the old dates (to the left margin) of the orders that will remain as the were the month before and you write the new date as the day the doctor signed his order. now the mar is looking all messy (with pen ink) now who gets it typed up??? that is the right thing to do, when she gets the order, she changes it on the mar with black ink and fax the order to pharmacy.
and is part of the lpn responsibility to fax a copy of the actual monthly doctor order page to the pharmacy or was that taken care of before the doctor bring his new monthly order's to the floor??? it is our responsibility to fax all order to pharmacy and make sure they are carried out in the appropriate places.
i'm silly right...but i really have to know (lol). i have student loans to pay and i want to feel secure in my job so as not to fall apart...palleeese help!!!!
4. if a resident complains of something such as an eye issue i will call their regular doctor and let him know, question: do i have to fill out anything on the opthom. consult form or is it up to the attending doctor and the consulting doctor to fill out???
thank's for reading my post (i really needed to know how the different processes work so i can be efficient when i start working on my own, especially since i'm sure 9 am med pass my take me all of 4 hours, lol).
please answer as much as you can--thanks much.

1. at my facility, i call the family every time a wound, skin tear, fall etc happens to a resident. we also have to fill out an incident report. as far as new meds are concerned, i don't call the families for that because you would be on the phone all night. most families who are overly concerned will come to you and say "can you tell me what medicine my mom is on?" some med changes come from discussions from supervisors with families. ie care plans. whoever called the dr. to get him to prescribe an antipsychotic or antianxiety has called the family to discuss this or the family may call the facility to request that their family member be put on something like that due to the behaviors they have seen while visiting. usually all this is a multidisiplinary team effort but the best thing to do is to ask your supervisor and check your facility policy.

2. medications changes happen all the time, anytime at a facility. i'm not sure about a monthly dr. order but if there is something on their that needs to be seen or done on a certain day, its quite possible to refer to that document several times a month to make sure nothing was missed.

3. when a resident is admitted. the discharge summary arrive with them. this tells the facility all the medication orders and, diagnosis, h&p special services needed. who ever does the admission(usually an rn) will write out all the order and you will have to sign the orders off and fax them to the pharmacy so they can send the medications. usually the rn will write all the order on the patients mar. again check your facilities policy on that because at my facility, we (lpn's) don't do admissions or call the dr, for orders. the rn supervisor does all that.

the pharmacy sends typed mars to the facility every month, that is why it is important to fax all dr. order to the pharmacy. at the beginning of each month. we the nurses have to compare the current month and last months mars when we pass meds to make sure that last months order are carried over to the present month.

for example. mr. h starts predisone eye drops tid dec 28-jan 4. you would have to make sure this order is written on the january mar so people will know to do it.

4. if a resident complains of eye pain or anything else, you need to assess the situation.(is there dirt or a foreign object in their eye? do they need their eye drops?) . i would alert the supervisor if there is nothing on the mar or standing orders that you can give them. your facility should have a list of standing orders for medications that can be given to each patient to address things like dry eyes, nausea, pain, indigestion, constipation. you do not call the dr. for simple things like this. does your facility have a supervisor on duty (like an rn) as a lpn you should not have to make all these decisions by yourself. also you need to ask more questions and write them down. it will get easier but don't be afraid to ask questions because it will decrease your anxiety when you have to work alone. remember that every facility has different rules and regulations. i answered the questions based on my facility. you need to get more clarification pertaining to your facility. good luck.

kuyah12 · Jan 19, 2008

Thanks for the reply NC girl 35. I really needed that it help me to for a basis for all the question I will have to ask this coming week on my second week of orientation.:rcgtku:

peridotgirl · Jan 19, 2008

Good Luck on Orientation!!!:cheers: :nurse:

pagandeva2000, LPN · Jan 19, 2008

This was helpful to me as well, because I am a clinic nurse who plans to do med-surg per diem. Thanks, NC girl 35!

ursus57 · Feb 20, 2010

:yeah:Thanks, gold foil star applied to name badge! Soon to begin LPN prn @ my facility. :yeah: :hpygrp:

PunkinLPN · Feb 22, 2010

Just a little tidbit... The best thing to do when you first come out of nursing school is to work in a hospitial either full time or PRN if you can.... You will learn sooo much

Redbirdgirl88 · Mar 4, 2011

i hope its going well for you now. i can't seem be able to post a new thread yet ( just joined) but i really need to know something quickly about transcribing. When you get a bunch of TO orders at once, do you repeat each one back to the caller after each order is verbalized to you? Or do you wait until he tells you everthing he orders and then repeat them all back at once, or does it matter, as long as you read them back to him. Thank you!!! Someone help!