physician orders

[panurse101]

I was wondering what the rest of the long term care facilities do regarding orders not "really" recieved by a md. For example: patient's family requesting family member gets sent to ER for evaluation...the MD says he doesnt want the patient to go to the hospital, but family still wants them out..you send the patient to the ER...do you write the order.."send to ER" TO/ Dr. ..... or if its facility policy to administer a ducolax supp. after no bm in 3 days..... is this actually a MD order.. or is having a policy enough coverage for you??

[CoffeeRTC, BSN, RN]

As far as sending pt to the hospital without an order... if the pt and family want the res to go...they go. Call the facility medical director and get an order from him or her. You can't write and order from a doc who won't approve or give you the order. Make sure everything is well documented.

The facility policy should be reviewed with all mds and approved in the orders or modified per MD request. We do this on admit and on monthly recaps. For example we do prune juice them MOM then ducoloax then enemas. Some residents have bowel issues for years and doc might just change the orders. Bottom line.. I think it needs to be an order even if its facility policy.

[mineral]

In the facilities I have worked in you do not need an order from the physician to send the resident to the hospital. If the family requests it, do it, unless the resident is of sound mind and refuses to go.

[miss_nurse2004]

If a resident states they want to go to the ER...they are sent at their own request and the doctor is informed that they are going, and why. At times, when we call the md and tell him the problem, he says do this - do that. We tell the resident what the doctor ordered, and if the resident says they would rather go to the er, then they go. Their choice.

As for family members, if the resident is unable to make the decision on their own, we can send the resident per family request and write the order accordingly. I call the doctor and inform his nurse that the family is requesting for so-and so to go to the er for an evaluation and ask her to inform the md. All our doctors understand this situation, and they always sign all the orders. No problems. And as always, document everything! (This comes in handy, say, when you've been paging the MD for 2 hours with no results and the family has waited long enough...and they want the resident sent in)