Orders from a PA not co-signed by MD

P_RN, ADN, RN · Mar 6, 2005

I believe that would vary from state to state. In SC a co-sign is required.

DutchgirlRN, ASN, RN · Mar 6, 2005

Can anyone share their hospital's policy on PAs writing orders? For years (and I've been around for 20 of those) our policy has been that the PA writes orders like they've been in direct contact with the MD - i.e Dr. Brown/T. Hall, PA.
The covering MD then has 24 hours to co-sign the order. I also thought that this was a JCAHO requirement. We've recently had two new PAs start working at our hospital and they are writing orders independently and the docs have not been co-signing them. I'm taking this issue to our medical staff services office but I'd like to know what other hospitals are doing?

I'm in Tennessee and I asked this question of the CNO just last week. We take orders the same as if the Dr had written them, the Dr's have 48 hours to sign behind them. Hope they are doing that!

P_RN, ADN, RN · Mar 6, 2005

i found this that "kind of" answers your question.

http://www.aapa.org/gandp/statelaw.html

personally several years ago i carried out a written antibiotic order written by a pa ( i verified with one of the physicians in the group by telephone.)

the pharmacy sent the minibag, i gave it. the patient was fine. the admitting doctor came in later that day and viciously scratched through the original page where the order was. he said he never authorized the abx.

fortunately the pharmacy had the copy and the medical committee agreed with what i had done. from then on though i always got a cosign.

jwk · Mar 6, 2005

Can anyone share their hospital's policy on PAs writing orders? For years (and I've been around for 20 of those) our policy has been that the PA writes orders like they've been in direct contact with the MD - i.e Dr. Brown/T. Hall, PA.
The covering MD then has 24 hours to co-sign the order. I also thought that this was a JCAHO requirement. We've recently had two new PAs start working at our hospital and they are writing orders independently and the docs have not been co-signing them. I'm taking this issue to our medical staff services office but I'd like to know what other hospitals are doing?

It's not your responsibility to make sure the order is co-signed. It's the physician's responsibility, and medical records should follow up. Why are you so worried about it? It's not any different than a verbal order given to an RN. It gets signed off later by the MD. Would you wait for the MD to actually sign the verbal order before you carry it out? I doubt it.

You're covered by both state law and hospital policy if you follow the orders that the PA has written. I'd be more worried about not following the orders because you have a personal issue about the PA writing orders (which they're legally authorized to do) and the doc co-signing, and then something happening to the patient because of your inaction.

sharann, BSN, RN · Mar 6, 2005

It's not your responsibility to make sure the order is co-signed. It's the physician's responsibility, and medical records should follow up. Why are you so worried about it? It's not any different than a verbal order given to an RN. It gets signed off later by the MD. Would you wait for the MD to actually sign the verbal order before you carry it out? I doubt it.
You're covered by both state law and hospital policy if you follow the orders that the PA has written. I'd be more worried about not following the orders because you have a personal issue about the PA writing orders (which they're legally authorized to do) and the doc co-signing, and then something happening to the patient because of your inaction.

This is exactly correct. The M.D and PA's are responsible for getting these co=signed,not the nurses. Stop trying to be accountabl for everyones actions. We tend to do this because nurses are so versatile we can't help it :)

pkapple · Mar 6, 2005

The co-signing really varies from state to state and from facilities within those states. Some PA's can provide hospital care with no cosignatures, some facilities require the v.o. MD/PA thing--which is exactly what an RN does. Many states have laws that the MD must cosign a percentage of PA charts, some require all charts within 30 days, some never need to cosign.

It is truly a hospital policy and the responsibility of the PA and the MD supervisor to know the policy of that hospital.

In FL the PA can write orders in the hospital, but the chart notes need to be cosigned. Of course every hospital has regulations so a PA who does things one way at City Hospital, does them another at Cross the Street Hospital.

And don't even bring the confusion of differing rules ARNP's into the mix!!!!

kathys76 · Mar 6, 2005

It's not your responsibility to make sure the order is co-signed. It's the physician's responsibility, and medical records should follow up. Why are you so worried about it? It's not any different than a verbal order given to an RN. It gets signed off later by the MD. Would you wait for the MD to actually sign the verbal order before you carry it out? I doubt it.
You're covered by both state law and hospital policy if you follow the orders that the PA has written. I'd be more worried about not following the orders because you have a personal issue about the PA writing orders (which they're legally authorized to do) and the doc co-signing, and then something happening to the patient because of your inaction.

My concern stems from (and maybe I didn't make this clear in the original post) the hospital's policy states that the PA should write the covering physician's name and then theirs on the order. If we're not in compliance with hospital policy and give meds based on just a PA's order.....I think there would be a liability problem if something went wrong or as someone else responded, the doc came in and said he never authorized the order. We all know that when stuff trickles downhill the nurses are the ones with their arms out waiting to catch it. We have a policy at our hospital that covers this...I just wanted to know if other places were different or if anyone was having the same problem.

sharann, BSN, RN · Mar 7, 2005

My concern stems from (and maybe I didn't make this clear in the original post) the hospital's policy states that the PA should write the covering physician's name and then theirs on the order. If we're not in compliance with hospital policy and give meds based on just a PA's order.....I think there would be a liability problem if something went wrong or as someone else responded, the doc came in and said he never authorized the order. We all know that when stuff trickles downhill the nurses are the ones with their arms out waiting to catch it. We have a policy at our hospital that covers this...I just wanted to know if other places were different or if anyone was having the same problem.

Kathy, :)

Maybe I am misunderstanding your post, but as I read it you are concerned with PA's not being in compliance with policy. If the physician disputes the order later--tough. That is between the PA and the physician. Unless I am totally missing the point here? :confused: