New to LTC, does signing off MD orders mean something different here?

[auntiedebe]

Hi, I am having difficulty adjusting to LTC and MD orders. I have 20 plus years experience in INPT, ICU, and ER; but am having difficulty understanding roles here. Is it different in LTC when you get a MD order? I was taught that you could receive an order without signing it off, e.g. a RBTO, but when you signed it off or noted it, that showed that you had taken responsiblity for putting it in all the appropriate places like the MAR, the computerized charting system (not yet using eMAR), entered the lab orders, made the appointment, or whatever the order states.

In my facility, we have a Resident Care Manager who asks that we put all the pink copies of the orders in a specific place, but she feels that signing in the "orders received by" space means the order has been completed (and it is not completed.) Does this happen other places. I am trying to find a policy/procedure that states how MD orders are to be processed, but can't find one. Does anyone have a source (even from nursing school) that talks about completing MD orders? Help!

[KarenJordan]

Most of the facilities I've worked at had the noc shift nurse transcribe all the orders to the appropriate place. The last two facilities I worked at, the rule was if you received the order, you transcribed it. Most facilities here now only have one night nurse so they don't put it on them anymore.

[tellis6645]

Obviously every facility is different! At my facility if you take the order, you take care of it. If our manager takes an order from the doctors, she is the one to make sure its carried out. I have on occasion signed out orders that werent carried out during random chart checks, but its not the norm. These are orders that were written by the doctor and missed, not telephone orders! We dont carry out others telephone orders. So in answer to your question. In our facility, no you cannot take an telephone order and not carry it out. Its considered your responsibility.

[CoffeeRTC, BSN, RN]

Most of the facilities I've worked at had the noc shift nurse transcribe all the orders to the appropriate place. The last two facilities I worked at, the rule was if you received the order, you transcribed it. Most facilities here now only have one night nurse so they don't put it on them anymore.

So if 7-3 or 3-11 gets an order, it isn't started until the next day if 11-7 is transcribing etc? How is this not a delay of care?

[CoffeeRTC, BSN, RN]

I think I understand what the OP is saying. A few times if I am swamped with things, I will get the order, write the verbal and keep it flagged. RNS and LPNS work closely so I will let the LPN know of the order and then when we get time etc take the orders off together.

Most often it could be for labs (we have two places to write them too) or maybe a diet change etc.

For the OP..what we do in this case is just flag the order. If it is flagged, it still needs taken care of. That way everyone knows what still needs done.

[auntiedebe]

Thanks to everyone for your helpful words! I guess to a former CCU/ER RN things are certainly handled differently in LTC. I am glad that orders received but not completed are flagged. I will start there in trying to set up a procedure for handling orders so none get missed. I filled out 10 incident reports in my first couple shifts for labs or treatments that had been missed due to the mishandling of orders. Again, thanks all!