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New RN sup still orienting but full of questions

Posted

Ok mainly i wanted to know.. It sounds stupid but what do you call and tell the MD when there's an admission ? Just that they have arrived ? How do you do med reconciliation ? Does the hospital provide a list of meds and then u read them off to see which meds he wants to continue?

Depends on the facility most likely. Each hospital or facility will do things differently depending on facility policy. At our facility we notify the MD that a new admission is here. They come up within x amount of time to assess the patient and get a basic history. We as nurses also get our own patient history and reconcile their medications in the computer which the MD later puts the orders in when the med rec is complete.

The facility you are referring to may or may not do things this way. Your best bet would be to ask your preceptor if you are still on orientation to see exactly how your facility recommends you go about this process.

"The only stupid question is the one you don't ask."

Ok there must be somewhere to put the meds in then . The assessment will be the easiest part of the admission.. I planned on asking I just thought maybe I could get a general idea

Yes, more than likely there is an area within your documentation system where you can add and view patient's home medications. You can then review these meds with the patient to ensure that the dosages are correct and add and change things as needed.

At our facility, once this step is completed by the nurse, the MD then reviews the home meds and places orders in for their home meds and any other meds they choose to prescribe r/t the patient's condition. These orders are then transmitted to pharmacy.

To be clear I didn't mean anything negative by the quote listed above. Just threw it in there due to your statement "it sounds stupid but..." No such thing as a stupid question. :) Hope this helps a tad.

So if it's 8 pm and there's an admission will the doc submit a diet order relatively quickly then ?

amoLucia

Specializes in LTC.

A diet order has probably come with the admission paperwork. If your pt is A&O, ask them. You've got to know that they have had something to eat that eve. And they need to eat in the morning.

Just a suggestion - BEFORE you call the MD, do a quick review of transfer orders, get a set of VS, and do a quick assessment with a body/skin check (for wound care). You want to have as much info or new details known/covered as poss. You'll want to avoid calling MD back, calling MD back, calling MD back... Have all your duckies in order. Esp those things that hosp transfer orders forget, like glucometer readings, labs, foleys, O2, consults. Get your orders for PAIN MEDS and SLEEPERS.

Sounds like you do admissions the old-fashioned way. Call with your requests as early as you can. The MDs will more likely call you back more quickly. If you're lucky, you'll reach the new NH attending, not the on-call doc. Technically, you can't give anything until your orders have been OK'd. And this is VERY important if you get admissions late 3-11 (or even 11-7).

LoveMyBugs, BSN, CNA, RN

Specializes in Pediatrics.

Those sound like excellent questions to ask your preceptor.

As they are facility specific.

My facility the nurses used to do the med rec, but now with our latest Epic upgrade, we don't. The MDs have to completely the medical history and do their own med rec, as they are the ones ordering inpatient meds.

They should place a diet order with their admission orders.

Again great questions, but really need to clarify with your preceptor

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 25 years experience.

I am kind of surprised that all orders aren't received by fax from the discharging hospital or facility well before the person arrives. At least that's the case in LTC, I am not sure what setting/type of facility you are in. We won't accept an admission without a full nursing screen, including a review of all orders prior to an admission.

I am in ltc but no I don think we receive orders ahead of time we have to call and notify the physician of the admission and they submit the order set ( I haven't done one yet so I could be wrong)

You should develop a close relationship with your immediate supervisor at work. Many of your questions could easily be answered by your supervisor and then you would have the added assurance that you are following the policies of your institution as well as keeping your supervisor apprised of your acclimation to your new role.

4boysmama

Specializes in Hospice + Palliative. Has 4 years experience.

I'm in a SNF on the sub-acute rehab unit, and we get a set of discharge recommendations from the transferring hospital that comes to the facility with the pts discharge paperwork when they arrive. when we get report from transferring hospital prior to transport, we find out if they have any narcotics, and request that they provide a written script for the narcs (so that we can immediately fax to pharmacy and get authorizations to pull from the EDK, because most times pt's are asking for pain meds upon arrival). The rest of the orders get reviewed by our in-house NP if it's during the day, or called to the on-call physician and read off for confirmation in the evening/at night. We do had to toe assessment prior to calling doc, so that we're able to answer questions that might arise. We have standing orders that are put into place for all pts (may sub generics, may crush meds that are crushable, etc) but all other orders must be verified by NP/MD before we can give/do anything to the pt.

I'm surprised this wasn't covered in orientation? They are good questions but it's not a good idea to ask for clarification on facility specific protocols on an international nursing forum.

My advice would be to talk to your manager and perhaps ask for an extended preceptorship.