Nurse order botox without MD order

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Specializes in med surge, Interventional radiology,.

So I worked in an outpatient surgery center that was relatively small and new. As two of the main RN we had access to cardinal health where we had the ability to order any medications expect narcotics with our MD information already saved into the system. One of the nurses order botox several times. after I noticed this I asked our MD if he was aware of the nurse using his name and license to order botox for personal use. He mentioned that he was not aware and that was the end of the conversation to an extent. should I report this nurse to the board of nursing for ordering botox without an MD order or permission. the RN took the medication of the premises and had someone else inject her with the medication. for more information our facility does not use botox for any patient use or patient care.

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First, let me ask you this:

22 hours ago, milo&otis said:

As two of the main RN we had access to cardinal health where we had the ability to order any medications expect narcotics with our MD information already saved into the system.

Is this really how it was? Such that if you felt it was fine for a patient to have something you just ordered it under the physician's name without actually having received any kind of order for it?

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22 hours ago, milo&otis said:

should I report this nurse to the board of nursing for ordering botox without an MD order or permission.

If you go this route be prepared to get caught up in the net. 

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OH there are too many questions about this post ---

The post begins "So I worked...." Has the OP left this employer? 

If Botox is not used at the facility for any patient use or procedures then why was Botox being kept at the facility? 

The post eludes to the fact that said nurse falsified an order to gain the RX for Botox... then how was it dispensed if it was taken off site to be administered? Is there no tracking system in place that a dose take matches a dose ordered? No inventory control? 

Did this nurse steal this dose or bill it to their insurance? Neither a good option given the story we know thus far. 

Most EMRs will in fact allow proxy's (such as RNs) to enter provider orders - such as voice and/or phone orders - but the provider will be notified and have to sign off on that order the next time they log into the system.. Seems that this step appears to missing in this EMR system.. or are the nurses actually using the providers login credentials to place these orders? 

I have to agree with the other 2 posts that have been made.... OP you may be about to open yourself up to a world of trouble -- even as a new nurse you should have had the knowledge that any/all these practices should not have been happening. 

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3 hours ago, 203bravo said:

Most EMRs will in fact allow proxy's (such as RNs) to enter provider orders - such as voice and/or phone orders - but the provider will be notified and have to sign off on that order the next time they log into the system

The key is that all of these orders that nurses think they are ordering independently where the provider's name magically populates actually do need to come from somewhere. They are either a verbal, telephone or protocol order, etc. Not just Nurse So-and-So wants to order something and so "voila!" because look the computer let me do that under the provider's name.

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1 hour ago, JKL33 said:

The key is that all of these orders that nurses think they are ordering independently where the provider's name magically populates actually do need to come from somewhere. They are either a verbal, telephone or protocol order, etc. Not just Nurse So-and-So wants to order something and so "voila!" because look the computer let me do that under the provider's name.

Yes I agree,, hence the double check of having the provider sign off at their next log in.  Otherwise it's basically the same as getting a blank RX pad writing what they want then signing the Doc's name. 

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31 minutes ago, 203bravo said:

Yes I agree,, hence the double check of having the provider sign off at their next log in.  Otherwise it's basically the same as getting a blank RX pad writing what they want then signing the Doc's name. 

The problem is that the double-check idea has become perverted in a setting where there are a lot of pressures and even more contrived/created pressure of related to time ("efficiency").

I don't think the double check is sufficient at all. It's basically making someone else take responsibility after someone else has already done something.

Anyway, to stay on track here, I suspect that the ability to enter orders and have providers sign them later (because admin says they must) contributes to a scenario where a number of nurses out there think they can order things when, as a matter of fact, they cannot. They can perform the function of entering an order that they have received from somewhere else; that is all. As far as scope of practice is concerned that is the most we are actually allowed to do.

I'm not trying to get off track but just stress the point that is a possibility in the OP as well - this OP seems to think that it isn't the ordering by nurses that is the problem (since their system lets them order things under the physician name) and that the only problem here is that this one nurse went beyond that and did other wonky stuff. Well -- none of them are in the right if they really think that they can order things in a computer system without actually having received some kind of order.

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I read this differently, I don't think the OP is referring to entering an order in CPOE for the pharmacy to dispense.  I think, based on the following, the the nurse in question was ordering the medication from an external supplier, and diverting it for her or his own use.

On 5/28/2021 at 11:54 AM, milo&otis said:

So I worked in an outpatient surgery center that was relatively small and new. As two of the main RN we had access to cardinal health where we had the ability to order any medications expect narcotics with our MD information already saved into the system. ...

[...]

 

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Specializes in med surge, Interventional radiology,.

spot on the nurse was ordering from an external supplier. the facility did not have a pharmacy to dispense medication. She was diverting it for herself. Like one other post that came up with the analogy of a blank prescription pad in theory. There is no EMR or verbal order or telephone orders to take and put orders in. This was a small facility not a hospital so no pharmacy no inventory check for medications expect narcotics.

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Ohhh....so you didn't mean ordering, as in a provider writing a nursing order to give a patient a medication, but ordering as in ordering stock/supplies for the clinic.

I don't have much to say about that, really. I just don't involve myself in this stuff unless I have to. This physician is not running a very tight ship and my preference would be to not work for someone like that.

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Specializes in PICU.

What patient name is this RN using, is it themselves?

A provider would still see that medications are being ordered.

Since the provider did not seem to care, per your post, maybe the provider does have some knowledge as most would be very irate that their name and license were being used. 

How can the nurse log into the system to order this? Why does the provider not get notification that a medication is being ordered for a patient.  meds can't just be ordered without a patient name.

 

 

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