RNs to write Diagnoses for medications?

[dinah77, ADN]

Hi all, been a nurse for bout 7 months, and quick question

I work on a TCU, and at my facility often times patients come without a clearly stated diagnosis for their medications on file- Our DON has us fax the physicians with med lists asking for a diagnosis for each medication to put on our MARS- it is a stupid waste of time, usually the docs are VERY slow at responding, and in my opinion it makes us seem stupid- What is the diagnosis for Prozac for this patient? Could it be the diagnosis of depression listed in her history?? * insert eye roll here*

Anyhow, one of our in-house docs is actually an NP (hooray!) and every time we give her one of these sheets, she hands it back with a note saying "Nursing to do"

to which I think "Darn right!" after all, isn't this within our scope of practice? They made us do this in Nursing school for clinicals, so why can't I do it now??????????

[morte, LPN, LVN]

I don't believe assigning a medical dx is within nursing scope....I see your point, especially when it is there in black and white.....perhaps sending the list with the note "these are in her hx" please sign and return???

[GM2RN]

I understand the frustration with the speed of the doctors' responses, but this is not a nursing function. There are many medications that have more than one use, and some have "off-label" uses.

Pozac, uses for: clinical depression, OCD, bulimia nervosa, PMDD, panic disorder

Prozac, off-label uses for: body dysmorphic disorder, fibromyalgia, hot flashes, PTSD, Raynaud's phenomena

It might seem obvious that prozac, especially in your example, is being given for depression. But what if the patient's history is wrong or incomplete? I have worked a TCU and you get a lot of elderly people who are poor historians. Personally, I wouldn't risk getting it wrong.

[LTV950rn]

I agree with above. For example, I once had a patient with CF who took Narcan (yes, Narcan), for constipation. I don't recall seeing that in any drug book. So many meds are used for other means that the prescribing doc should be the only one to make that call.

[evolvingrn, BSN, RN]

my son takes depakote for seizures , others take it for mental health reasons. he also takes levo-dopa which automatically makes you think its for parkinson disease but we actually use it off label. so while a lot of things are 'obvious' i think the prescriber should clarify the actual reason. I think when they write the orders for the meds there should be a place for 'indication' which would solve this problem completely. that is how it is at our place if they don't fill in that section then we leave it blank.

[morte, LPN, LVN]

I agree with above. For example, I once had a patient with CF who took Narcan (yes, Narcan), for constipation. I don't recall seeing that in any drug book. So many meds are used for other means that the prescribing doc should be the only one to make that call.

I believe this is done to counter the gut level reaction to opiod pain meds....

[Horseshoe, BSN, RN]

hi all, been a nurse for bout 7 months, and quick question

i work on a tcu, and at my facility often times patients come without a clearly stated diagnosis for their medications on file- our don has us fax the physicians with med lists asking for a diagnosis for each medication to put on our mars- it is a stupid waste of time, usually the docs are very slow at responding, and in my opinion it makes us seem stupid- what is the diagnosis for prozac for this patient? could it be the diagnosis of depression listed in her history?? * insert eye roll here*

anyhow, one of our in-house docs is actually an np (hooray!) and every time we give her one of these sheets, she hands it back with a note saying "nursing to do"

to which i think "darn right!" after all, isn't this within our scope of practice? they made us do this in nursing school for clinicals, so why can't i do it now??????????

no, it is not within our scope of practice to make medical diagnoses. you did not do this in nursing school-you made nursing diagnoses, which as you know, is not the same thing by a long shot. sorry, but the docs need to do this.

[elkpark]

No, it is NOT within our scope of practice to make medical diagnoses. You did not do this in nursing school-you made nursing diagnoses, which as you know, is not the same thing by a long shot. Sorry, but the docs need to do this.

I think what the OP is referring to is tracking down (in the medical record) and making note of the medical diagnoses the physician had already made -- we all were expected, in clinical, to be able to discuss our assigned clients' medical diagnoses and why, specifically, they were taking the medications they were taking -- but I agree that, in this situation, it should be the responsibility of the physician or other prescriber to indicate the specific reason a medication is prescribed, given the extent of off-label usages these days.

[Horseshoe, BSN, RN]

I think what the OP is referring to is tracking down (in the medical record) and making note of the medical diagnoses the physician had already made -- we all were expected, in clinical, to be able to discuss our assigned clients' medical diagnoses and why, specifically, they were taking the medications they were taking -- but I agree that, in this situation, it should be the responsibility of the physician or other prescriber to indicate the specific reason a medication is prescribed, given the extent of off-label usages these days.

I hear what you are saying, but if we begin to make assumptions based on doctor's notes, we are, in essence, going beyond our scope of practice. Writing down a medical diagnosis on a MAR, even if correct and gleaned from clues left in the medical record, is not what we did in clinicals-in nursing school we made nursing diagnoses, and that is not what she is discussing in the OP. We can certainly talk about rationale for drugs in the nursing process, but the OP specifically states that the MAR (part of the official medical record) requires a medical diagnosis, and that is not something she is allowed to make, regardless of how obvious it seems in the doctor's notes. For this reason alone, this is something the docs must do (although the off label use argument is certainly also valid).

[NotFlo]

I think what the OP is referring to is tracking down (in the medical record) and making note of the medical diagnoses the physician had already made --

No, I don't think this is what she's talking about at all. She's talking about coming up with medical diagnoses to match the meds...medical diagnoses that are not already in the notes or in the chart. This is clearly not in a nurses' scope. The MDs need to do this. We don't make medical diagnoses.

[netglow, ASN, RN]

Op, your NP is saying "nursing to do" only because she doesn't want to sit and do that stuff either. Same with the doc. It's just more paperwork. Legally speaking the MD has to do it.

I look at it differently, I'd like to avoid pushing paper too. I do not see it as something to seek out, no nursing glory in it for me.

[dinah77, ADN]

I think what the OP is referring to is tracking down (in the medical record) and making note of the medical diagnoses the physician had already made -- we all were expected, in clinical, to be able to discuss our assigned clients' medical diagnoses and why, specifically, they were taking the medications they were taking -- but I agree that, in this situation, it should be the responsibility of the physician or other prescriber to indicate the specific reason a medication is prescribed, given the extent of off-label usages these days.

THANK YOU! this is actually what I was referring to - and what I was getting at in my OP- ( posts at 2:00 AM are often not as coherent as they could be) I'm mainly talking about tracking down in the history meds that have long been prescribed and stating what it says in the history- I am NOT talking about meds that are new and not clearly spelled out somewhere int their history

I DO realize that meds are often prescribed for not obvious reasons- for example, I recently had a female patient on viagria, which freaked me out until I found out it was cardiac related