protocol for giving op er narcotic injectables

[MGM33]

I am a nurse supervisor at a small hospital. Myself, my DON, Pharmacy and ER supervisor are trying to devise a policy regarding ER and OP ER visits in which the physician is ordering narcotic injectables. During our research we are getting many conflicting information. EMTALA will state one thing, the DEA another etc, STate board of nursing another. Our conflict stems from When a patient comes into ER with a Headache and we call the physician do they have to come in a do a medical exam or can the nurse do it take a phone order, tx the patient then send them on their way. Our hospital currently has may 'frequent flier' so to speak and we are revising our policies. EMTALA the way we are reading it states that a nurse cannot 'medically diognos a patient but can do a nursing assessment call the physician and recieve a verbal diognosis and orders and the physician never even see the patient.We are a small facility and do not have a inhouse ER doc all the time. What are your thoughts?

[sjt9721, BSN, RN]

There is a difference in OP and ED patients. ED patients fall under EMTALA regulations and require a medical screening exam, which as you correctly interpreted, is not performed by nursing staff. (Nurse triage does not equal medical screening exam.)

The physician should not order narcotic injections unless they have seen (as in the ED) or have a prior relationship (PCP) with the patient. We will see OP things in our ED after-hours and on weekends. BUT...we have a chart on the patient which includes an H&P and physician orders.

As for the docs who call us to say "Joe Blow is coming in for a HA...go ahead & give him a shot of Morphine"......well, I can't carry out his order unless he's coming in to see the patient. That's when the PCP usually says, "Oh, just let the ED doc see him."