Ridiculous waste of time

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Specializes in acute care and geriatric.

Recently our pharmacist has asked that we get a doctors order and prescription for every time we use vaseline (like to protect chapped lips) or skin cream ( for dry skin) or zinc-oxide based protective cream (used routinely after diaper changes), etc. .

We use these things often and if we were to wait for a doctors order- the problem would be exacerbated. We also don't have the time for this and the doctor certainly doesn't.

I wrote a note to our CEO - that if we were to put this into practice we'd need more doctor and nurse hours.

I suggested an across the board order on all the patients upon admission for all these things but the pharmacist wants it charted and monitored, something that the nurses have no time for.

Is it like this by you?

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Specializes in Telemetry/CVU/CICU/CVICU/Neuro-ICU/SICU.

That Is Absoulutely Ridiculous...!!!! I Am So Sick And Tired Of All These People Other Than Nurses Making All These Great/drastic Demands When All They Do Is Sit On Their Bum All Night And Cud Not Even Put On A Nasal Canula If They Were Paid A Million Dollars.

The Pharmacist Should Not Even Have A Say So In All Of This. They Have Absolutely No Patient Contact As Far As I Am Concerned. I Hope This Is Not Passed At Your Hospital. Hell If It Was Passed At Our Hospital......i Would Just Put The Vaseline On And Call It A Day...its Really Not That Serious!!!

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Specializes in PICU.

I am a travel nurse and have found it to be common practice to have to get an order for diaper rash cream. The hospital I am at now gets around this by having it preprinted on admission orders so Dr's just have to check a box for diaper cream of choice and 4 or 5 different ones show up on the MAR and you just choose one. Vaseline is still available for lips as a freebie though

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It is all about who pays for it. No script = no pay/reimbursement easy as that. So don't go blaming the pharmacy it is just doing the best it can to keep the funds flowing in rather than out. You and I know it cost more for labor than they will ever get back with nursing time and pharmacist time and billings time etc... But some one thinks it will save money, so you need to talk to them and show how it will cost more to do it their way than the way they want to do it and your troubles will all go away just like that pesky rash.

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The lotion and vaseline should be stock. Vaseline for lips and lotions for the body should be part of normal care. Zinc is considered a med so I can understand getting an order. Maybe you should see about having put as a standing order or as part of your wound protocol. Just my :twocents:.

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Why not just get the med staff to make it a standing order as part of the admission assessment? It shouldn't be a big deal- am sure docs won't like getting pages asking for an order for lotion.

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I suggest getting it preprinted on the admit orders. You will need to watch that people who dont need it, doesn't get it ordered.

Seems stupid, but sometimes for a bad rash, we do get orders for the zinc or butt paste, so if it is an order, a nurse needs to make sure it is done. (yeah...a basic nursing care, duh?)

Can't you just write a verbal for it?

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Specializes in LTC,Hospice/palliative care,acute care.
Recently our pharmacist has asked that we get a doctors order and prescription for every time we use vaseline (like to protect chapped lips) or skin cream ( for dry skin) or zinc-oxide based protective cream (used routinely after diaper changes), etc. .

We use these things often and if we were to wait for a doctors order- the problem would be exacerbated. We also don't have the time for this and the doctor certainly doesn't.

I wrote a note to our CEO - that if we were to put this into practice we'd need more doctor and nurse hours.

I suggested an across the board order on all the patients upon admission for all these things but the pharmacist wants it charted and monitored, something that the nurses have no time for.

Is it like this by you?

Vaseline is ordered for fragile extremities as "preventative skin care q shift " for several of our residents and it is helpful with cutting down on the number of skin tears we see. Butt paste is also an order with a stop date and it is billed through the pharmacy.OUr policy states that we use a&d ointment and lubriderm lotion for routine care and these do not need to be written as individual orders. That stuff is supplied by the nursing home along with the rest of the toiletries. YOur Q & A person can monitor this-or the pharmacist can say "hello" to the monthly HCFA and roster -they include all the info they need regarding treatments,rashes and open areas on each unit....Why do we do all of this paperwork if no-one ever READS IT?
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Specializes in A little of this & a little of that.

Where I have worked all skin care products except lotion and products for chapped lips were required to be "official" orders from the MD and charted on the treatment record. This provides the record needed to bill for the assessment that goes along with prevention and treatment of skin breakdown. Such things as A&D and butt creams that are for prevention are usually PRN or BID indefintely. Everything else that is for treating skin tears and minor breakdowns must have a stop date so that they are re-assessed and the MD notified of any change. The state looks for this during survey as proof that good skin care and preventative measures are being implemented.

Most OTC products are "house stock" so that they are provided to the patient without actually putting through a script for them. Medicaid does not pay for OTC products on an individual basis. All these little things are what enables a nursing home to increase their daily Medicaid re-imbursement rate, the primary income source for US nursing homes. I don't know how re-imbursemnet is handled in Israel, but perhaps there is a similar reason.

In hospitals more routine things are provided without specific orders because the billing rates are set differently. Hospitals just bill the patient for whatever is ordered in that patients name. A lot more is considered "routine nursing care" that doesn't necessarily require the doctor's order and more is allowed for "protocol". A lot of time is wasted in LTC to satisfy the state and to prove to Medicaid that care is being provided.

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i recently attended an in-service where he said you needed orders for creams/dressings containing zinc, but vaseline?! thats insane ... and such a waste of time on top of all the millions of things we already do!

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Specializes in Post Anesthesia.

at our hospital the medical practice counsel and P&T committies approved a list of Nursing orders for OTC minor meds like the ones you mentioned. They are charged as "supplies" rather than medications- even though they come out of pharmacy.

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Specializes in PICU/NICU.

CRAZY!! Our pet jelly is on our "central supply" cart so we are free to use it whenever. "Butt cream" is another story- however we have a box the MD checks on the admission sheet for "skin care per nursing order" so that we can get desitin/bacitracin or whatever we need without the ordeal. Maybe you could just get a standing order???

On that note, there must be some pharmacy crackdown going on because Just yesterday, I took an order for Tylenol 150 mg po/pr q4 prn..... the pharmacy called me back and said that I need to write PRN WHAT.... fever or pain??? OMG!!! Why do they care???? Yeah... apparently we have to say PRN why now.:eek:

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