Physician Orders

[miccay]

In the facility where I work, I have a nurse consultant that comes monthly and completes an audit on the MDS I have completed. She always comes up with one more physician order that she says I should have coded. I know what the problem is. I was taught that you do not code physician orders that are written the day of admission unless it is because of a drastic change in condition of that resident. She is wanting me to code orders from the day of admission such as when the MD changes one medication to another or wound treatment orders. These are not clarification orders ( I know they can not be counted), but they do not indicate a change in the resident's condition. I have looked in the manual for clarification and I still believe I should not be counting these orders. She states she has always counted such orders. Should I be counting them? Please advise.

[AlleeBooRN]

i am new to mds and this is confusing to me, i know it will come in time awaiting others advice. thanks for your post.

[CapeCodMermaid, RN]

I never counted day of admission orders. And I worked for the big K....

[Ruas61, BSN, RN]

It is rare that an admit day order gets counted by me. Check with your state RAI coordinator would be a good alternative source.

Who is the Big K Mermaid??

[CapeCodMermaid, RN]

Kindred. If there was a way to make a nickel, they would have done it. We never counted admission orders.

[Talino]

i was taught that you do not code physician orders that are written the day of admission unless it is because of a drastic change in condition of that resident. she is wanting me to code orders from the day of admission such as when the md changes one medication to another or wound treatment orders. these are not clarification orders ( i know they can not be counted), but they do not indicate a change in the resident's condition. i have looked in the manual for clarification and i still believe i should not be counting these orders. she states she has always counted such orders. should i be counting them? please advise.

the rai says ...

includes written, telephone, fax, or consultation orders for new or altered treatment. does not include standard admission orders, return admission orders, renewal orders, or clarifying orders without changes. orders written on the day of admission as a result for an unexpected change/deterioration in condition or injury are considered as new or altered treatment orders and should be counted as a day with order changes.

the best way to find out is asking the md why the medication or a treatment is changed. if it's ineffective (improper dosage, less potent drug, unnecessary), caused adverse effects, poses a threat for undesired interaction w/ other meds, etc. then the order change is necessary to obtain a cure or prevent injury, thus a day of order change. if the order change is due to cost, a drug is non-formulary, the drug manufacturer is stingy w/ gifts, then it's not.

[catmom1, BSN, RN]

If the order change is due to... the drug manufacturer is stingy w/ gifts, then it's not.

That was really funny, Talino. Thanks for making me laugh.

Catmom :paw:

[susanthomas1954]

Kindred. If there was a way to make a nickel, they would have done it. We never counted admission orders.

Too funny, I worked for them too. It makes you really marketable on your resume though. Everyone wants the nickels you learned to earn. They just don't have the weasels teaching for them.

[lisaRN37]

I count everything that is not a standing house order at admission. Might be wrong but no one has told me it is yet :flwrhrts:

[pixie120]

In the facility where I work, I have a nurse consultant that comes monthly and completes an audit on the MDS I have completed. She always comes up with one more physician order that she says I should have coded. I know what the problem is. I was taught that you do not code physician orders that are written the day of admission unless it is because of a drastic change in condition of that resident. She is wanting me to code orders from the day of admission such as when the MD changes one medication to another or wound treatment orders. These are not clarification orders ( I know they can not be counted), but they do not indicate a change in the resident's condition. I have looked in the manual for clarification and I still believe I should not be counting these orders. She states she has always counted such orders. Should I be counting them? Please advise.

I understand it to be this: number of Physician orders that are NOT simply clarification orders on day of admit. The way I get around this, is make sure write new orders day of admission, not hard to do, hospital orders are always messed up and wrong. An admission from hospital to SNF IS a drastic change, for the better, supposedly, we are to monitor that change (drop in level of care needed) so there is a change (any admission, discharge implies change). If the order is just "Clarification order: blah, blah, "no. Teach your admission nurses to write new orders with the docs on day of admits, easily done as soon as they complare the home meds (pre-hospital med list) with the discharge list of hospital meds or as we have, a house policy that we can implement baseline labs to be draw 2nd day of admit, to see the baseline for OUR admit for this patient (this is usually on the medicare side but we do it for all new admits).