I have also been contemplating the many replies to my dilema. Maybe I wasn't too clear. The patient in question had been at our facility approximately 2 days; had not been treated as of yet, by of our out-pt. Psychiatrist when she went into the hospital.
Well, who-the-hecks' med orders were being followed to medicate the client for the two days she was at your facility before she went to the hospital? I have run into situations like this as a surveyor for my state -- the agency administration needs to explain to the doc(s) that he (they) are getting paid big bucks to be RESPONSIBLE FOR THESE CLIENTS, and he (they) need to step up to the plate and do their *******' job! If not, the agency needs to find new docs who are willing to do so. Otherwise, client care suffers and
the nurses get left to dangle in the wind ...
I am having a hard time understanding how any nurse could feel that it is better to go back to the old drug regimen pre-hospitalization for a stabilized patient while awaiting a reply from the out-pt. doc?
I was not suggesting that you return to the old regimen (esp
. if that wasn't ordered by your treating psychiatrist, either!! Who was
it ordered by? How can you admit someone without some kind of admitting orders from your
doc?) The issue is that you have no valid (legal) medication orders for this client from a physician authorized/privileged by your agency to treat its clients. The docs need to be available to you, at least by 'phone, for these kind of situations -- that's what they are getting paid for, and what they are legally responsible for.
As for "suggestions"vs orders. The "suggestions" I received from the Hospital were on legal prescription pads.
Now, if you were admitting someone to an inpatient unit, psych or med-surg or whatever
, and s/he arrived with a handful of Rxs written by a physician somewhere else who did not have practice privileges at your hospital, would you "honor" those Rxs and give the client the meds without orders from "your" physician? No, no, no, no, no ... This situation is no different. As maureeno noted, your most appropriate action is to at least contact the treating (agency) doc by 'phone, review with him/her the discharge med recommendations from the hospital, and get orders from your
doc. That covers you until the doc can see the client ...
I think the lesson here for our agency is to develop a protocol that ensures the highest quality patient care!
This is always the lesson!
I hate to sound like a nag, and I'm not trying to be critical of you, specifically -- you're just getting caught in the middle, and the agency administration and the docs need to sort all of this out. I have been a surveyor in psych facilities in my state for the state and the Feds for the last several years, and it has always amazed me how often I have had to explain the legal basics of predicaments like this to RNs, MDs, and administrators. You and your agency would be in serious trouble in my state in the situation you describe if the state regulatory agency found out about it. However, the rules in IN may be completely different and you may be fine ... But
, the agency needs to be sure that y'all are in compliance with your state rules/regs, that the docs are doing the job they are getting well-paid to do, and that the clients' needs are getting met appropriately. Best wishes!