noting orders..... who is licensed to do this?

[eyknough]

Hi all, I have a question about physician's orders and I figured this is a good place to go! :)

I started a new position today, and a person who I was introduced to as a medical record's organizer plopped a stack of physician's orders in front of me for me to "second sign". Their policy is that two people are to verify physician's orders and two people are to initial each order in the MAR to verify the order is correct and safe.

I couldn't read the signature on the orders, so I asked one of the other nurses whose signature I was "second verifying". They told me it was the MA who noted the orders and that this MA also sometimes fills out the MAR for you to second verify as well.

I was further informed that this person is not even certified as a medical assistant, and that this person's highest education level is high school. This person also happens to be the nursing director's offspring.

I figure it's not really my duty to necessarily verify this person's credentials, but if this person is on the schedule as an MA then I figure I am safe to treat this person like an MA, which does not include seconding this person's noted physician's orders.

Is it even legal for an MA to note physician's orders or to transcribe them to the MAR? Anywhere? I thought this was the exclusive domain of the RN, nationwide. I didn't notice that any of the orders were verbal orders; they were all hand-written by the doc. So that takes some of the danger out of the equation, but I am a little confused as to how to deal with this. Perhaps I am mistaken and with the proper inservicing and training the MA can note orders? I sure know that in the N-Clex world it is only the RN who may note orders, period.

It really gets under the skin of the nurses I worked with, and even though this person has been nothing but pleasant to me it really irked me as well. I worked my little tail off in school for years to be licensed to note and transcribe physician's orders!

What do you think?

I did not second the MA's noted physician's orders.

[applewhitern, BSN, RN]

Only a nurse can enter medications on the computer at my facility. However, back when we used paper MARS, the unit clerk did it. The nurse (RN or LPN) "verified" the orders and signed them. Everything is on computer now, but if an incorrect med passes from the doctor, thru the pharmacist, to the nurse who gives it, the nurse is the one responsible for the error. Makes me wonder why we don't get paid what pharmacists make, since they claim any med error falls on the nurse.

[DoGoodThenGo]

I think I'm thinking too far into it myself. :) Just being cautious.

It's interesting how important they made medication order noting and medications in general sound in school. I've never had to question an order yet besides perhaps informing the doc of a patient's extremely large size when a 0.1 mg clonidine was ordered.

Boy they sure scare the heck out of you about these things when we're being taught.

Still, though. There's just something about unlicensed people noting orders that gives me the heeby jeebies. I know I'm the last possible chance to catch a potential mistake when I'm passing meds, but having the question in the back of my mind whether or not people who knew what to look for were involved in at least noting the orders will give me even more cause to pause and think.

Good brain exercise, I suppose.

Psu, I agree that to verify it is safe and compatible requires a nurse, doc or pharmacist. I thought that's why it was required that a nurse note the orders even though a pharmacist is in the loop. Nursing instructors made it seem like we nurses are responsible for catching any possible mistake that can be made by any healthcare professional and ancillary staff.

Perhaps it was overkill to keep people questioning things... such as me. :)

Thank you for your input. I'll ease up on the notion of an MA noting orders, especially since they're requiring 2 people to note the orders.

Caution is a great thing, don't ever lose that sixth sense. *LOL*

Here is one hospital that combines nursing assistant duties with ward clerk. Note no mention of license or even certification but the job description covers transcribing orders: Ward Clerk/Nursing Assistant « MontevideoMedical.com

[jadelpn, LPN, EMT-B]

I get a little weirded out about second signing anything--as in our facility, we don't note orders unless we complete them. Unit secretaries can note "entered", they can trascribe onto MARS, but 2 nurses need to verify against the orders and sign off. This takes some mindfullness, as there have been double signed nurse MARS and the transcription is incorrect. So you just have to be sure you check before you sign.

As far as MA's originally noting the orders--for what purpose? She entered them?

As I said, the only thing I am familiar with is noting orders when they are completed (or verified) by the nurse. And I am not sure an MA is in the position to complete the orders.

Chart checks are also done by nurses, who continually insure that the orders are correct. But again, you have to have some sort of knowledge that the patient is being cared for under the order's direction. And I am not sure the MA is the one that can know this, as scope prevents this.

Also be careful that you do not put your signature with an unlicensed personnel, as I am not sure the policy/legal obligation surrounding this practice, until you are sure what that obligates you to.

I would call your BON and see. If you have malpractice insurance (and I would!) call and ask for their guidance.

[TheCommuter, BSN, RN]

I was further informed that this person is not even certified as a medical assistant, and that this person's highest education level is high school.

Certification for medical assistants is purely voluntary. It is not legally mandated or anything of that nature. In fact, schooling for MAs is totally voluntary, as some physicians hire them off the street and train them.

Is it even legal for an MA to note physician's orders or to transcribe them to the MAR? Anywhere? I thought this was the exclusive domain of the RN, nationwide.

Yes, this action is perfectly legal. Furthermore, it is not the exclusive domain of the RN. It is the domain of anyone who has been trained to perform the task, and this includes unlicensed personnel.

Contrary to the textbook world of nursing, noting and taking off physicians' orders does not require years of education or training. Rather, it only requires basic knowledge. By the way, unit clerks are the ones who take off orders and note them at my workplace.