physician compliance

[joamy2]

How does your hospital handle discharge medication orders? Are your physicians required to write out all discharge home medications or can they write "resume home meds?" If they are able to write resume meds, how do you get around JCAHO's standard on no blanket orders? Any help is greatly appreciated!!!!

[meownsmile, BSN, RN]

Any medications that we have had ordered while the person is inpatient is able to be printed off of the computer. This sheet along with a preprinted discharge instruction sheet (which the doctor also has to fill out and sign) is put under the discharge tab in the chart. The doctor then initials each med he/she wants to continue on discharge and signs the bottom of the page. Any others that may not have been started while inpatient are hand written either on the bottom of the printed discharge med sheet they initial or they write a handwritten order on our order sheets and they are then transferred to our computerized instruction sheet by us, that also shows when the medications were last given (date and time). All is reviewed with the patient on discharge by the RN doing discharge teaching, or copies of all are sent to the LTC or wherever they are going.

It works pretty well, we just have to make sure they address any meds that hadnt been started at the hospital so they arent overlooked on discharge.l

[limabean]

This is a sore subject with me. At my hospital, physicians are not supposed to write "continue home meds." However, there are only maybe two or three who comply with this. The nurses are educated EXTENSIVELY about this. Why are the physicians not???? Why do we have to do all the work all the time with this?

If a physician writes "continue same home meds" we are supposed to call them and verify each med with them. (Just write them out for goodness sakes.) But, as has happened to me many times, suppose it is 1800 when you get the order and the physician who wrote the order is now not on call. So you call and get the "on call" doc. This doctor doesn't know anything about this patient so how is this safe practice?

If the hospitals would enforce the rules with the physicians as much as they enforce them with the nurses the hospital would be a much safer place.

I did really like the idea of having a sheet that the physicians can print out at discharge and initial the meds they want cont. for discharge (from the previous poster.) We have a similar procedure for when a patient transfers from surgery or another floor. The docs are supposed to circle each med to cont. but this rarely gets done. Very frustrating! :angryfire

[meownsmile, BSN, RN]

limabean,, it took us a few months to get the docs used to actually looking for this when they discharge a patient. It is going much more smoothly and actually have most of the doctors "trained" to ask for one if they cant find it on the charts.

If it doesnt get done when they discharge the patient, the patient stays until we fax the papers, get them signed etc, and the office faxes it back to us.

They dont like to be bothered inthe office with it, so most will make sure they get it done before they leave the hospital now.

[gamegirlkimmy]

Seems like much of the time the physician's are the most resistant to following policy. Many times they are not updated on ever changing policies and documentation requirements. In any case they must still be held accountable for non compliance. We had a really tough time getting the docs in our department to stop using cc, u, and ms. The nurses had been doing great but those docs just couldn't seem to remember (especially the older docs). The management team decided to do a monthly QA and we randomly pulled 2 charts per day and checked for "do not use abbreviations" and made a monthly compliance report from that. We turned in a copy of this report to the department chief as well as individual reports to each physician. In 3 months our compliance was 100%.