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Home health, Med/Surg
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RNinSoCal has 13 years experience and specializes in Home health, Med/Surg.

Born and raised in California

RNinSoCal's Latest Activity

  1. RNinSoCal

    Need resource for MD orders guidelines please

    You are misunderstanding. They are doing this on the regular order pages outside of the monthly printed orders forms-on the hand written daily order sheets. The regular MD order sheets look like a confused mess with orders crossed out everywhere. I have never seen anything like it. If it was just correcting the monthly orders I wouldn't be asking this question.
  2. Hello educators, I have run into a problem with nurses crossing out MD orders that have been changed or discontinued at a LTC facility. For example an order written on the MD order sheet reads "6/15/10 Tylenol 650 mg po Q 6 hours prn for mild pain Dr. Knowitall" If the MD writes new order "6/25/10 DC previous Tylenol order. Tylenol 325 mg po Q 6 hours prn for mild pain Dr. Knowitall" the nurses are crossing out the order on 6/15/10 on the MD order sheet and writing DC'd next to it. I hope that was a clear example. I tried to tell the DON that the order on the MAR needs to be crossed out and re-written but never the order on the MD order sheet. She thinks that this practice is OK. I have been looking for some kind of book or article that would give concrete proof that this is poor nursing practice so that I can pass it along to the DON. Does anyone have a resource or reference that I could use to help improve the nurses practice with MD orders? Thanks in advance for any assistance.
  3. RNinSoCal

    crossing out MD orders??

    I have not been able to find any professional nursing or medical texts/articles on orders charting. I wonder if there is a standard for orders that I would be able to bring to the nurses as evidence. They don't know me well enough to know my years of experience with hospital and JCAHO orders compliance and some outside documentation would be useful. If anyone has a book or article to recommend I would appreciate it.
  4. RNinSoCal

    crossing out MD orders??

    I agree, it makes the original order appear to be invalid. It also could look like nurses are trying to falsify medical records when viewed from a legal standpoint. I have to say something to some of the nurses who are doing it. I already talked to DON and she thinks it is OK. I have no power over this situation. I have been entering the MD orders for monthly order printouts for 2 months and there have been no errors.
  5. RNinSoCal

    crossing out MD orders??

    OK, here is what they are doing: MD order on regular order sheet " 6/15/10 Tylenol 650 mg po q 4 hours prn mild pain Dr. Knowitall" The nurse receives new telephone order from MD on 6/24/10 for Tylenol 325 mg q 4 instead of 650. She goes back to original order on 6/15/10draws a line through and writes changed then writes new/changed order. I do not understand why anyone whould draw a line through an older order on a regular order sheet. The new order is the valid one and the nurse needs to change the MAR not the MD order sheet. This is not just the printed re-cap it is happening on. I know it is bad nursing practice but as a previous poster said feathers will ruffle if I try to tell DON what to do. CHW (former employer) would have had a cow over this kind of nursing practice. I am happily doing MDS forms today.
  6. RNinSoCal

    crossing out MD orders??

    Thanks for responding! I thought it was wrong too. I asked the DON if it was done on all order pages or just the monthly printout and she said on any order sheet! State should have fun with her:eek: I am just the alternate MDS nurse, not in charge of pt care at all. Maybe she will ask someone since I questioned it.
  7. RNinSoCal

    crossing out MD orders??

    Hello all, I have not posted here before. Switched to MDS nurse (LTC) from med/surg for a change of pace. My feet still hurt from all the years of med/surg!! Not that LTC nursing is easier, just MDS work. I am helping to enter MD orders for the monthly physician order printouts (since the nurses here do not know how to use a computer and the medical records person is new). I noticed that the nurses are crossing out MD orders when an order is changed or DC'd. It is so strange to me. It seems wrong to cross out an MD order. In acute we would just write the DC or change in order and leave the older orders alone. Is this a common thing in LTC or just a totally wrong practice at this facility??? I am learning this is a different world from acute. It IS a nice change of pace though. Thanks for any input.