RNs to write Diagnoses for medications?

[dinah77]

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??????????

[core0]

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??????????

My question is why are you doing this at all? Is there some rule that requires every medication to have a diagnosis attached to it? Where I work in the hospital the MAR just has the medications no diagnosis attached to it. I would agree with the NP. The administration of the MAR is within the domain of nursing. If someone in nursing has decided that the MAR has to have extraneous information on it how is that the physicians responsibility? On my side I am responsible for reviewing all the medications that the patient takes every day and deciding if they are still appropriate. The only time that I would see the need for a diagnosis is on a PRN drug. Technically it doesn't have a diagnosis, its an indication for administration.

David Carpenter, PA-C

[Katie5]

The time it took for the NP to pen that down, she might as well have simply written the diagnosis.Just saying.

[Katie5]

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

Freaked out over viagra?LOL:uhoh3:

[rkitty198, BSN, RN]

A nurse I work with had to write all of the diagnoses related to the drugs she had to give to the patients in the mar next to each drug when she worked LTC.

A nurse cannot diagnose, but writing a diagnosis just proves you know what the drugs are for. Some facilities consider this a safety mechanism.

[GLORIAmunchkin72]

Our MAR includes all of the DXs, and I think it's a good thing. Many times a resident will ask me what am I taking this for and the dx on the MAR is a clear cut answer. I don't want to have to guess if the drug is given off-label, as many are.

A nurse I work with had to write all of the diagnoses related to the drugs she had to give to the patients in the mar next to each drug when she worked LTC.

A nurse cannot diagnose, but writing a diagnosis just proves you know what the drugs are for. Some facilities consider this a safety mechanism.

[rkitty198, BSN, RN]

GLORIAmunchkin72

I totally agree, it would be very nice! I was giving Codeine to a patient post-op. I figured it was for pain and I wondered why the MD would choose that over something else. I did some research (that we never have time for) and it was to slow transit time through the bowel because he had short bowel syndrome!

[morte, LPN, LVN]

My question is why are you doing this at all? Is there some rule that requires every medication to have a diagnosis attached to it? Where I work in the hospital the MAR just has the medications no diagnosis attached to it. I would agree with the NP. The administration of the MAR is within the domain of nursing. If someone in nursing has decided that the MAR has to have extraneous information on it how is that the physicians responsibility? On my side I am responsible for reviewing all the medications that the patient takes every day and deciding if they are still appropriate. The only time that I would see the need for a diagnosis is on a PRN drug. Technically it doesn't have a diagnosis, its an indication for administration.

David Carpenter, PA-C

long term care regs, not hosptal....

[DNP54]

I'm starting to think more and more that these medication reconciliations must be profit driven. I'm going to make it a point to see if it is some kind of requirement for reimbursement or somthing. The exact same thing has happened at my hospital, and the calls to physicians have gone up about 40%. Some nurses are just filling in the Dx or indication based on common uses. I stopped doing it when I got into the 'off label' territory with a patient. I assumed that she was taking Megace for her appetite since she appeared cachectic, and then the MD told me that she was actually taking it for hot flashes. Needless to say, they both thought I was a bone-head, and I was annoyed for our management for putting us in the situation that we had to guess what the med was prescribed for. We still have some paper charting, and don't have time to go down to Medical Records and pull the old charts or research each medication, every hospitalization, from every PCP or specialist. I'm all for letting it que up for the MD's to address with their discharge instructions. I sense a checklist in the works...

[GM2RN]

My question is why are you doing this at all? Is there some rule that requires every medication to have a diagnosis attached to it? Where I work in the hospital the MAR just has the medications no diagnosis attached to it. I would agree with the NP. The administration of the MAR is within the domain of nursing. If someone in nursing has decided that the MAR has to have extraneous information on it how is that the physicians responsibility? On my side I am responsible for reviewing all the medications that the patient takes every day and deciding if they are still appropriate. The only time that I would see the need for a diagnosis is on a PRN drug. Technically it doesn't have a diagnosis, its an indication for administration.

David Carpenter, PA-C

It's probably policy where the OP works. I've seen it done at one hospital before. I actually think it's a good idea, just not that nurses assign the diagnosis.

[Music in My Heart]

I don't know about you but I've got enough of my own work to do to eschew doing any of the provider's work. It is the provider's role to provide those diagnoses and I will happily leave it to them.

[Music in My Heart]

My question is why are you doing this at all? Is there some rule that requires every medication to have a diagnosis attached to it? Where I work in the hospital the MAR just has the medications no diagnosis attached to it. I would agree with the NP. The administration of the MAR is within the domain of nursing. If someone in nursing has decided that the MAR has to have extraneous information on it how is that the physicians responsibility? On my side I am responsible for reviewing all the medications that the patient takes every day and deciding if they are still appropriate. The only time that I would see the need for a diagnosis is on a PRN drug. Technically it doesn't have a diagnosis, its an indication for administration.

David Carpenter, PA-C

David, I believe that it's a Medicare requirement for the SNF folks. We have a "swing bed" program whose patients are SNFers but on the acute floor for specific reasons whose LOS will far exceed the approved stay. As part of our "swing" paperwork, we have to provide the Dx for each med; we never do this for our regular acute admits.

[dinah77, ADN]

Thanks to all the responses! It's been intersting- yes it is facility policy we have a diagnosis for each med, probably because we do have a lot of Medicare pts.

And no, I really don't relish the idea of taking on work I technically don't have to- I just tend to get a little impatient sometimes and when someone is taking FOREVER to get back to me on something, I tend to have a "Screw it, I'll just do it myself type of attitude;)