Processing physician orders

jnette, ASN, EMT-I · Nov 12, 2003

At the hospital I'm orienting to on m/s the secretary wll place the order on the computer. The nurse then goes into the computer and verifies that the order has been placed, then writes "verified" and initials the actual order in the chart. When we have no secretary, the charge nurse will put the order in the computer, and another nurse must still go into the computer, verify it's there, and check it off in the chart.

amycar11 · Nov 18, 2003

i really envy your system... at least, you get to have your inputs in a computer...

in the hospital where i am presently having my hospital exposure as a student nurse, we are still in the "medieval" (hehehe) way of carrying out doctor's orders...

i think that policies about how to process a doctor's order can be learned, in due time... it gets to be pretty much routinary after a while...

what i really don't like about this "doctor's order thing" is when you CAN'T understand what they write!! they keep on scribbling their orders and "most" of their penmanship is just terrible!! i know that it's our responsibility to "ask" if we can't understand their order... but it' just so unfair when we get blamed...:zzzzz :devil:

BarbPick · Nov 18, 2003

In the Miami area, I have found the only thing ward sec's do is fax a copy of the meds to the pharmacy. They take off every order like Dx and Labs and enter them in the computer, but the nurse has to physically write the medication orders on the MA R's when it is a new order.

then there are 12 hour order checks by the nurse caring for the patient along with signed 24 hour order checks signed at the bottom of the doctor's order sheets. A lot of red ink.

Gldngrl · Nov 18, 2003

Our system is completely done by computer. The physician, NP, or nurse enters the orders in the computer, they spit out the printer and are in the system. We have computer generated kardexes for pt care and meds and we sign off meds, bld transfusions, IV's, etc. by computer, so the secretary, nurse doesn't have to sign any orders off. Makes things very easy. The only thing nurse orders is IV meds or routine meds if it's out of stock or contaminated, etc. If the computer goes down for extended period of time, then we go to paper as our back up system but I've only seen this 2 times in 3 years that I've worked there. MMB

IamRN · Nov 19, 2003

Originally posted by jnette
At the hospital I'm orienting to on m/s the secretary wll place the order on the computer. The nurse then goes into the computer and verifies that the order has been placed, then writes "verified" and initials the actual order in the chart. When we have no secretary, the charge nurse will put the order in the computer, and another nurse must still go into the computer, verify it's there, and check it off in the chart.

This is the same experience I have had at the many hospitals I have worked at.

You should look at your specific facility's policy. You can bet there is one, just no one bothers to follow it! :eek: If there isn't one, maybe you should aproach your manager about your concern. It seems to me if there isn't a policy then your actions (if ever questioned) will not be backed up!

mattsmom81 · Nov 19, 2003

When we sign off orders it means they are all initiated ie labs are in computer and med orders faxed to pharmacy, consults initiated, etc. So if a secretary enters it, we must double check.

Our night shift then does a 24 hr followup chart check...so it is two nurses taking responsibility. Regardless if a secretary enters lab requests into a computer, the nurse is responsible if she signs off the chart.

Do we get hectic and sign off without double checking??? Occasionally...but then our butt is in a sling if it is wrong.

Blanche · Nov 19, 2003

:eek: Our system is archaic. The Nurse recieves the order, she faxes the order to Pharmacy, the Patient Care Provider enters the orders, The Nurse enters the Med orders on the MAR, The Nurse checks the orders in the computer. The nurse hopes the orders are correct. The Nurse goes to the Pixis and finds the Pharmacy has not entered the orders. The Nurse calls the Pharmacy and finds out that the medications are not available and will not be until the next day. The Nurse writes not available on the MAR. The Doctor reads this and yells at the Nurse. The Nurse is taking care of her patients with her PCP who entered the orders incorrectly.The Nurse Manager is yelled at because he is at the nurses station. The nurse is then yelled at again.

The We will soon have a new system. JAHCO is requiring in 2005(? I think the date is) A paperless system for safety with bar code readers in each nurses hands, a bar code on each patient's wrist, amd bar codes on each indivigual medication packet.We will be gearing up for this system. I hope it works like it should. I keep thinking of the numbers which each person will be required to wear in Revelation. Then I think of the numbers tattooed on each person in the Nazi concentration camps. Those Tattoos worked well, but at what cost to the freedom of the person who wore those numbers. Our patients are more important than the system. They deserve accurate care. They also have the right to refuse at any time. The Doctors a in a hospital to serve the patients just as the nurses are there to serve the patients. When this system becomes manditory, don't forget we are there to serve the patient, not the system. We need to meet the needs of the patient, not the doctor, or the pharmacy, or our own needs. :nurse:

mattsmom81 · Nov 19, 2003

I had no idea it was being mandated. We will be going to this next year too. Seems like an even more time consuming system for nurses to deal with. But I guess I will see for myself soon,, and the hospital will be whining about paying us overtime....we already can't get out on time and they just keep adding more to our 'to do' list.

These 'new improved' systems always seem to benefit everyone BUT the nurses.

BedpanSally · Nov 20, 2003

When a duly authorized person writes an order,dated and timed, the unit secretary transcribes the order onto the Kardex, MAR, and into the computer system. "noted by" followed by her first initial and last name in red tells the nurse that the order was completed. The RN checks all of her orders that was written within her shift, but the night shift RN's actually go into the computer system and checks every order, doing a 24 hour check.

With the new JCAHO standard, any verbal or telephone order is written down, read back to the person giving the order to verify.

hope this helps.