"No New Orders Received" ..... ?

[RainDreamer]

When you notify the physician of something regarding your patient and receive no new orders, do you document that?

I can just document: "Notified MD of infant's increased work of breathing. Will continue to monitor."

OR

I can document: "Notified MD of infant's increased work of breathing. No new orders received. Will continue to monitor."

What do you do, and why?

[Sabby_NC]

Yup document document and document.

Time, the facts and the observations you have witnessed.

Keep the Dr abreast of changes even if no orders are forthcoming.

[AlabamaBelle]

I always chart that I notified the MD of the change(s) noted, the time, "no new orders" and that I "will continue to monitor". When/if the MD arrives at the bedside, I do note that. If I happen to get new orders, that's noted, too. I believe that is standard among the nurses in my unit - I remember hearing this during my orientation days. And we remind each other to note that we called.

Cindy

[rn undisclosed name]

I also write no new orders received. I will also chart what they say such as I will be up to see the patient and whatever else they said on the phone.

[snowfreeze, BSN, RN]

I document which physician was contacted and also if no orders were given. When I really feel that the patient needs further care/treatment/etc. I call another physician. I work in a teaching facility and have to deal with residents, I have worked in facilities with primary care physicians. When I was a newer nurse, my first 2 years or so I always got an experienced nurses opinion but when all else fails and I feel there is an imminent need, I call a code, that always gets a quick assessment by a physician. I would rather look like an idiot than have a dead patient. By the time I call a code I have all the vitals and appropriate information charted and quickly available for the code team.

[psalm, RN]

Here's another one... I will document the phone # I called doc at. We have had some problems with docs claiming they never got the call,"what # did you call?" I had one doc where I called his on-call pager x2, then his answering service, THEN finally his home phone. When he answered he said, you must not have called my pager, it's right here by the bed, what # did you call? When the # I gave him matched, he kind of backed down. But you better believe I documented the #'s and times I called

...called Dr. X at 555-2340 @ 0030 about pt BS, blah blah blah" have begun BS protocol...

...called Dr. X at 555-2340 at 0055 about pt. BS blah"

...called Dr. X at 555-4560, answering service # at 0105, about pt.BS, told by Amy to call home number if I do not hear from Dr. X in 15 min.

...called Dr. X at 555-3690, home phone # at 0115, received orders.

I will also write an incident report. Things are aken more seriously with a paper trail.

[Lorie P.]

I always chart the time, the doc called, the information given to the doc, example K+ 2.8 via labs not see above lab values (as some do,) orders received, implement K+ protocol, K+ blah blah given ( what ever amount of K+ to give, the time, route ) Or no new orders received, cont to monitor pt.

This has saved me more than once. Have also charted that " I'll be in to make rounds in about 20 mins, will take care of it then" as my response to having to call a doc and them tell me this.

[AliRae]

I think the reason for NOT writing "no new orders" is that it seems like you've given up, so to say. If you're charting that no orders were received, it implies that you think there should have been orders. By merely charting this, it can seem like you knew something else should have been done based on your patient's condition, but didn't fulfill your job as patient advocate by going up the chain to make sure you received appropriate orders.

Personally, I'm a "no new orders" charter, but that's the reasoning I've heard against writing that.

[Christie RN2006]

I always chart the exact time I first paged the doctor, how and why I paged (Paged Dr. X via office answering service to updated on pt increased difficulty breathing).

I chart when the doc calls me back, what I tell them and the outcome (Dr. X returned call to nurses station, updated on pt increased difficulty breathing, lung sounds course, lasix last given at XXXX, pt on 100% nonrebreather, O2 sats 92%. Dr. X states he is on his way. No new orders received at this time. Will continue to monitor.)

Always cover your butt!!

[Spidey's mom, ADN, BSN, RN]

I think the reason for NOT writing "no new orders" is that it seems like you've given up, so to say. If you're charting that no orders were received, it implies that you think there should have been orders. By merely charting this, it can seem like you knew something else should have been done based on your patient's condition, but didn't fulfill your job as patient advocate by going up the chain to make sure you received appropriate orders.

Personally, I'm a "no new orders" charter, but that's the reasoning I've heard against writing that.

That is what I heard too, at a conference. It makes sense.

Usually we have to go through the doc's office staff (MA or LVN) and they tell the doc and then the doc calls us back. So, I have to chart that I called the doc and message relayed by MA so and so or LVN so and so. If it is an emergency, I talk to the doc right away or I get the ER doc.

When the doc calls back for routine stuff - I document when he called and what the orders were . . or no new orders.

steph

[cardiacRN2006, ADN, RN]

I'm also a "no orders received" kind of nurse.

I document when each dr enters the room. I also document if I've updated anybody on pts status, whether it be on the phone or in person.

But I'm lucky, because we paper chart on a large flowsheet, and I can just jot the little things down quite easily---sometimes while I am actually updating the physician!

[RN4NICU, LPN, LVN]

I think the reason for NOT writing "no new orders" is that it seems like you've given up, so to say. If you're charting that no orders were received, it implies that you think there should have been orders. By merely charting this, it can seem like you knew something else should have been done based on your patient's condition, but didn't fulfill your job as patient advocate by going up the chain to make sure you received appropriate orders.

Personally, I'm a "no new orders" charter, but that's the reasoning I've heard against writing that.

I've heard that reasoning as well, but I don't buy it. I don't call docs just to chit-chat. The fact that I called implies that I think there should have been orders. Charting that none were received just provides documentation of what happened at that time.

[RainDreamer, BSN, RN]

That is what I heard too, at a conference. It makes sense.

Usually we have to go through the doc's office staff (MA or LVN) and they tell the doc and then the doc calls us back. So, I have to chart that I called the doc and message relayed by MA so and so or LVN so and so. If it is an emergency, I talk to the doc right away or I get the ER doc.

When the doc calls back for routine stuff - I document when he called and what the orders were . . or no new orders.

steph

What did they say about it at the conference? What did they recommend?