Protocol scenario...is this correct procedure?

[Bortaz, MSN, RN]

Scenario: If a physician writes an order, thusly: "Discontinue all antibiotics when blood culture is negative x 48 hours."

This order is written around the 24 hour mark (24 hours before it can legitimately be carried out).

The pharmacy will not accept "when" or "if" orders.

When the labs come back negative at 48 hours, would it be correct/safe/legitimate/whatever for the nurse to write a 2nd order to be faxed to pharmacy to get these meds stopped and off the mar? Without calling the physician for a new, distinct order?

What, if any, is the correct way to handle this situation at your facility/state/country?

[morte, LPN, LVN]

what is the pharmacy's reason for not accepting this order?

[Bortaz, MSN, RN]

Someone somewhere decided that orders to the pharm have to be specific, with no vague "if this" or "when that" because they said the pharmacy can't be responsible for making sure the guideline was met. So, we have to do it as a separate, specific order with no "if/when". They want simple "stop all antibiotics now" or even worse..."stop gentamycin now" as an order, "stop ampicliin now" as another, etc.

[morte, LPN, LVN]

So, the pharmacist gets to tell the doc how to write orders, practice medicine. And intrude in the doc/nurse relationship. Just great. AND, truly, they aren't responsible for seeing that the order is carried out, the nurse is! More dumbing down. oh well, not helping you any, sorry.

Someone somewhere decided that orders to the pharm have to be specific, with no vague "if this" or "when that" because they said the pharmacy can't be responsible for making sure the guideline was met. So, we have to do it as a separate, specific order with no "if/when". They want simple "stop all antibiotics now" or even worse..."stop gentamycin now" as an order, "stop ampicliin now" as another, etc.

[morte, LPN, LVN]

one way to work around this, I suppose, would be to have the doc write, after ___negative blood cultures dc all ABT. fill in the blank with how ever many blood cultures that would take. on the other hand, blood cultures take 72 hours to complete....

[Do-over, ASN, RN]

I would probably write the second order when the conditions of the first were met. Personally. In the signature line I would probably write something like "per previoiius order by Dr. So-and-so."

[bagladyrn, RN]

I would probably send the order to the pharmacy "as is" and when they call to object to it tell them "You will need to discuss any changes to the order with the provider who wrote the order. Here is his/her pager/phone number." I would not take it upon myself to rewrite any providers order in a way that changes any condition of it without a specific verbal order from the provider.

[sapphire18]

Sounds like a PRN order to me. Doesn't make much sense why pharmacy wouldn't accept it, but then, a lot of things that pharmacy does don't make much sense. (Is that sentence even grammatically correct??)

However, is the doctor really too lazy to be checking culture results every day? Doesn't he/she want to know what's happening infection-wise with the patient??

[wooh, BSN, RN]

We have an option on our drop down that's something like, "per previous order."

Yet again, another discipline making up rules that nursing has to jump through instead of working it out between the disciplines that are actually involved.

[Do-over, ASN, RN]

I actually work with a couple of pharmacists that will actually call the physician themselves. Now, just to get the physicians to talk to each other directly...