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.
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.
Thats what I'm hoping for- we are a 200 bed facility and the time it would take to order, write prescriptions and copy orders would be greater than the cost- don't forget then we'd need a separate tube/jar per patient, labeled, changed monthly etc. The nursing home now purchases large economy sized creams, they'd have to go to smaller individual ones.
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.
because the pharmacy wants a medical diagnosis, a stop order and charting to justify this,. They dont understand that the problem is chronic and recurrent- maybe today the skin is fine but tomorrow it wont be and we cant wait for an order before smearing some vaseline. We will have to chart chronic dry lips, dry skin, reddened buttocks on every patient every day. and then the doc has to chart as well. We are professional nurses we should be able to apply vaseline or skin lotion as needed without the work of charting, asking for orders, getting prescriptions, and follow up charting. We already put it in the nursing care plan. When will we be treated like professionals. Skin protection is an accepted nursing function- most docs I know ask nurses and defer to them for decubiti care.
Specializes in Gerontology, Med surg, Home Health.
CRAZY!!
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.
We've ALWAYS had to write PRN for what. This is nothing new.
When I first went to work in one place, the doctor told me he wanted to be called for EVERY order. So I called him for EVERY order, including a missed admission order for A&D to coccyx,heels, and elbows. I only had to do that twice before he said "Order whatever you want."
Specializes in LTC,Hospice/palliative care,acute care.
because the pharmacy wants a medical diagnosis, a stop order and charting to justify this,. They dont understand that the problem is chronic and recurrent- maybe today the skin is fine but tomorrow it wont be and we cant wait for an order before smearing some vaseline. We will have to chart chronic dry lips, dry skin, reddened buttocks on every patient every day. and then the doc has to chart as well. We are professional nurses we should be able to apply vaseline or skin lotion as needed without the work of charting, asking for orders, getting prescriptions, and follow up charting. We already put it in the nursing care plan. When will we be treated like professionals. Skin protection is an accepted nursing function- most docs I know ask nurses and defer to them for decubiti care.
You can apply that stuff without an individual order with a dx and stop date etc if it is included in your routine skin care policy.The cna's can use all of the OTC stuff....Your powers that be need to update your skin care policy.In LTC it's the "medicated" creams and lotions you'll need an order for.Check out your p and p during your next shift.This is the kind of thing that can be a big pain in the butt to the floor staff-a real time sucker -but it can easily be remedied in the front office.
We've ALWAYS had to write PRN for what. This is nothing new.
yup, amazed at the number of nurses who, either were never taught this, or have forgotten it. Without the reason, you cant give the tylenol, you would be practicing med with out a license.......
We've ALWAYS had to write PRN for what. This is nothing new.
When I first went to work in one place, the doctor told me he wanted to be called for EVERY order. So I called him for EVERY order, including a missed admission order for A&D to coccyx,heels, and elbows. I only had to do that twice before he said "Order whatever you want."
I am hoping that is what will happen here- I hope the doc does my work for me and complains.
I have to say how ASSININE! Ask the pharm. if you need an MD order to wipe their periarea with cleanser too! Sorry.... Get routine standing orders from your MD. Lip balm is part of cares...... Trust me, your MD will get tired of calls for orders of lip balm etc; he/she will give you standing orders. we even have standing orders for sunscreen....
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.
Get routine standing orders from your MD. Lip balm is part of cares...... Trust me, your MD will get tired of calls for orders of lip balm etc; he/she will give you standing orders. we even have standing orders for sunscreen....
achot chavi
980 Posts
Thats what I'm hoping for- we are a 200 bed facility and the time it would take to order, write prescriptions and copy orders would be greater than the cost- don't forget then we'd need a separate tube/jar per patient, labeled, changed monthly etc. The nursing home now purchases large economy sized creams, they'd have to go to smaller individual ones.