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??????????

[RNAnnjeh, MSN, CNS]

When I worked in LTC we were requried to have a diagnosis for each medication (on or off-label) and it was a requirement of the state licensing board for the LTC facility.

We would do the update on night shift and then when the doc came in in the morning we would get him to verify it.

It wasn't an issue.

[carolmaccas66, BSN, RN]

Why on earth do you need a diagnosis for every medication? What a waste of valuable time, I would certainly be questioning that. No wonder the docs are slow to do this.

[kanzi monkey]

I'm confused about this--if the patient takes the medication at home and the MD/NP/PA ordered it to be given while the patient is in the hospital, then THEY have obviously already considered why the patient is taking whatever meds he/she is taking and have decided that it's appropriate that the patient continue it while in house. I'm an NP and when I admit a patient I order all of their meds. If I have any questions about why they are getting a particular med, I ask the patient--if unable to answer, I find someone who CAN answer my question (ie, the PCP, or the rehab they were admitted from, or a family member, etc). If a nurse wants to know why a patient is getting a particular medication--s/he can simply ask me, since I ordered it. I'm not saying nurses aren't capable of linking many diagnoses with known medications. But that's not their responsibility. I would not ask a nurse to find out why my patient is taking Lasix--I would not order Lasix for my patient if I didn't know why they were supposed to be on it.

Does this make sense? Or am I missing something here?

[CJMR]

I'm confused. I guess I just didn't realize that it was not common practice to have the diagnosis for each drug prescribed. As the nurse, don't you have to monitor the patient for a therapeutic effect? If you don't know why the patient is taking a drug, how do you even know what you are monitoring? How do you know when to recommend to the doctor that the dosage may need to be adjusted or the medication should be held? It seems reckless to just give a med simply because it is written on the paper with no knowledge of what it is treating.

[canoehead, BSN, RN]

To make everyone semihappy the nurses could make a list of drugs with a guess at diagnosis and then fax it to the MD's to sign or correct.

I want to know what I'm giving drugs for, although many times I just assume it's for the most obvious reason. Usually docs write good information in their progress notes if it's an unusual situation. Probably better communication in the notes, and a detailed H&P would be helpful.

[Pappilli0n]

When nurses want to take over a doctor's role I say nursing is in trouble. Nurses have a hard enough time taking care of their own roles:nurse:. The doctor's role is complete involvement with his patients and that means including the

diagosis with each med ordered (I thought that was now a requirement). Nurses should never assume they know

what's in a doctor's head or his/her reasoning for ordering a particular med. It may not happen today and may never happen but when a case is brought against a doctor or nurse or hospital you'd best be well documented

for everthing that transpires around a particular patient. Cause and effect is what health care if all about. A

nurse thinking she is just as "smart" (I like using the word INFORMED here) as a patient's doctor is on her way

to trouble. Everyone should be responsible and held accountable for their own job. Let the doctor do his.