putting in orders and overriding meds

[nightlyrn]

I'm a fairly new nurse of 2 years. I have question to ask the nurses with more experiences. I had a very rough 2 days at wok last week. I had 2 admissions and 8 patients, so that's 10 in all. I also had a fall at the beginning of the shift, plus a very difficult family member. The patient wasn't difficult, but the family member was Both of my patients me in around 10 at night. It was just so busy that I didn't get to start both of my admissions by 12 am. The next day I found out that one patient was complaining that she hadn't receive her insulin night. Her blood sugar was good so she didn't needed insulin.... Another patient complained about not getting his medicine either. The DON told me in a meeting that we can put in certain medications as long as it is approved by the previous doctor at the hospital where the patient is coming from. Im a rehab nurse. Then we can override it. I just don't want to put any medications order in and giving it to the patient without the attnding physician at the rehab center approving it.

Is this out of the scope of practice?

[Pangea Reunited, ASN, RN]

Unless there's some type of very official and well-documented protocol, I would not order, override and give medication without an MD's approval.

[icuRNmaggie, BSN, RN]

What are the certain meds that the DON says that you can give without an order?

[nightlyrn]

The only standing order I knew of here was that you can put in an order for norco for pain (the charge nurse or supervisor can put the order in). I was working at a nursing home and med surge and all new orders must be called so that the attending physician will know. I'm just afraid that I will put in an order especially for insulin without calling the doctor. There isn't a pharmacy staff at night. If it was in the morning then I would verify with them.

From my understanding, the only time we could override medications is when the pharmacy has verify it or if the Dr. has physically put the order in or verbal or telphone order. Then we could put the order in. I just don't feel safe putting order that another doctor has put in while the patient was at another facility. I don't want to get blame by the attending physician for putting in order and overriding medications that he hasn't approved of yet.

[nightlyrn]

What are the certain meds that the DON says that you can give without an order?

Any antibiotics, antiepileptics, bronchodilators, analgesics, hypoglycemics, laxatives, antiparkinson. There is a few more. Even if I could do this, I wouldn't have the time with 2 admissions and falls. I also will be doing the doctor job of prescribing medications literally if I do this. I just have a bad feeling about this. All the other facilities that I have work at you had to call the physician or on call physician. I never put in an order unless I know that physician knows about it.

[MunoRN, RN]

Patient's being transferred to a facility from a hospital will have discharge medication prescriptions which any nurse can follow. If your facility has a rule that these prescribed discharge medications have to be reviewed by the physician for the facility then that's fine, but if they're aren't reviewing these meds at the time of transfer then you probably should be following the active (hospital discharge) medication orders until those orders are replaced or reviewed by your facility's MD.