Order for EKG?

Nurses General Nursing

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This is probably a stupid question, but I'm a new grad, so please forgive me. Do you need an order to run an EKG? I am assuming yes. I'm trying to study for the PBDS. Thanks in advance!

Specializes in Oncology.

And they don't cost $200, your facility may charge $200 for one but they cost about $5 in labor, plus the cost of a piece of paper.

Ours don't even get printed any more, but some electrons are severely inconvenienced.

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Like most things, check your P & P!

We don't need an order for a 12 lead, if it's warranted we do it.

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Is the order needed to run a 12 lead, or to attach the three lead, bedside, monitor/defibrillator?

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Specializes in PACU, OR.
Ours don't even get printed any more, but some electrons are severely inconvenienced.

:yeah::yeah::yeah: :lol2:

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Specializes in Medsurg/ICU, Mental Health, Home Health.

Yes, an order is needed in my healthcare system, but I am naughty and sometimes put the orders in before the doctor calls me back.

If a patient is complaining of chest pain...I'm ordering a STAT EKG and STAT CKMB & Troponin.

Also, if a patient is going to surgery that day, does not have an EKG during his or her admission and is 50 or older (or with certain comorbidities), I'm ordering it.

In both of those situations, I do let the doctors know and every time I've been thanked.

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Each hospital should have a policy on this. Like it or not a hospital is still a business and while you believe your time is only worth $5, your hospital may believe otherwise. Diagnostic testing does serve a purpose and regardless of how easy or simple an ECG seems to you, it should also be part of the patient's permanent record either on paper or electronically. Just because it is now stored electronically does not make it any less important which is like electronic charting. The electronic age has made comparing ECGs easier when you don't have to search through a mountain of old charts for a comparison with a previous ECG. Even a normal ECG can be of value later. Also, for those who complain their hospital is always cutting something, how much are you cutting your hospital?

(http://www.cms.gov/manuals/Downloads/bp102c15.pdf

Medicare requires cardiac testing, such as electrocardiograms (EKGs), be ordered by the patient’s treating physician or practitioner. If medical records are requested, proof of the physician’s or practitioner’s intent to perform the test must be submitted with medical records. According to the Medicare Benefit Policy Manual (the link I posted), Chapter 15, Section 80.6, the provider’s intent for testing to be completed should be documented by either:

  1. An order.

And/or,

  1. Other signed medical documentation supporting intent to order the test. Without a signed order or signed medical documentation supporting the physician’s intent to order the test, the service will result in denial upon review of medical records.

You may not have to be "ordered" to do an ECG but there should be some system in place that has a order set bundle or a manual entry for documentation. Just like any other diagnositcs, ECGs can be overused and unnecessary for some situations.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
That should be easy enough to cover. When you notify the physicians that you did an emergent EKG on their paitent, you ask if you can enter the order under their name to complete the process.

Each EKG machine records the data along with each EKG you have done and there should be someone monitoring the EKGs on that machine. If an EKG is billed without an order and it may be tracked to you for verification which if it is CMS, you really don't want to be known for billing for procedures that are not done. It is also not uncommon for a cardiologist to scan all the EKGs done in a hospital for quality and verification of interpretations.

*** We don't have an EKG machine. We just use the regular monitor and hook up the extra leads. We run them for educational purposes all the time, like to show orientees and students. Unless we hit the "print and send" the EKG never is recorded in the medical record. We can hit "print only" and unless we choose to place the paper copy in the patients chart nobody would even know we ever did it. The only cost to the faciliety is a sheet of blank copy paper and the ink to print it. Given vast waste of both paper and ink in my faciliety I was sort of under the impression that the hospital gets a kick back for using vast amounts of both.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Medicare requires cardiac testing, such as electrocardiograms (EKGs), be ordered by the patient's treating physician or practitioner.

*** You mean they require the order to reimburse? You are not saying it is illegal to run an EKG without an order in the absence of an attempt to bill for it? Like in the case of EKGs run for educational, not diagnostic purposes?

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Unless we hit the "print and send" the EKG never is recorded in the medical record.

*** You mean they require the order to reimburse? You are not saying it is illegal to run an EKG without an order in the absence of an attempt to bill for it? Like in the case of EKGs run for educational, not diagnostic purposes?

Are you asking if you need a physician's order for doing an orientation EKG? Probably not but on an EKG machine we usually enter a specific code name that alerts Cardiology that we are using the machine for teaching purposes.

Medicare requires cardiac testing, such as electrocardiograms (EKGs), be ordered by the patient's treating physician or practitioner.

I believe the above statement that you quoted is clear and the key word is "treating".

If you are actually treating a patient and charting that you did take some definitive action for whatever clinical situation you thought required an EKG, it would be nice that you had some proof to show later if ever questioned about the medications given or whatever was done or not done.

Most electronic monitors do have memory even if you don't hit "print". This info can be accessed in the event of a questionable situation. The same for most electronic devices such as some pulse ox machines, ETCO2 devices and most definitely ventilators. They can be your best friend or worst enemy in court.

Just curious, ever do a diagnostic test like an EKG on a co-worker who wasn't feeling good? Do you do an interpretation on the student's or orientee's EKG? What happens if the test is abnormal and they don't want to go to the ED?

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.

Are you asking if you need a physician's order for doing an orientation EKG? Probably not but on an EKG machine we usually enter a specific code name that alerts Cardiology that we are using the machine for teaching purposes.

*** We do not have EKG machines. We use the regular monitors that are already used on (nearly) every ICU patient.

I believe the above statement that you quoted is clear and the key word is "treating".

If you are actually treating a patient and charting that you did take some definitive action for whatever clinical situation you thought required an EKG, it would be nice that you had some proof to show later if ever questioned about the medications given or whatever was done or not done.

*** Yes, I see your point. "Treating" does seem to be the opperative word.

Most electronic monitors do have memory even if you don't hit "print". This info can be accessed in the event of a questionable situation. The same for most electronic devices such as some pulse ox machines, ETCO2 devices and most definitely ventilators. They can be your best friend or worst enemy in court.

*** Yes, I am well aware of that. The fact that they have a memory doesn't mean everything on it is part of the medical record.

Just curious, ever do a diagnostic test like an EKG on a co-worker who wasn't feeling good?

*** No, never done anything like that, nor would I. I have checked co-workers blood sugar, but not with the same hospital owned machine we use for patients.

Do you do an interpretation on the student's or orientee's EKG?

*** Yes. It has happend that the educational EKG showed something different than the patients diagnostic EKG.

What happens if the test is abnormal and they don't want to go to the ED?

*** Never had that come up.

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There are several advanced nursing protocols in place that we're allowed to implement without an order, and there have been many times when I've had a patient (usually female) complaining of vague or nonspecific arm or shoulder pain that I will call for an EKG. It's a noninvasive procedure and our physicians would rather us err on the side of caution than to sit and wait for one of them to show up and order it.

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