SCD orders

sandiegojames · Jan 30, 2008

I have to say, I have always been confused as to why we need a MD order to put on SCDs. Why exactly does this require an MD order? I see the point of writing an order if this is something they want. But I don't see why we also are not allowed to use our professional judgement and put them on ourselves? How exactly is doing this intervention outside of my scope of practice?

OR male nurse · Jan 30, 2008

Common sense should prevail with such a non-issue as this. I know which surgeons want SCD's on their patients and which don't. Many times I've gone to pre-op to pick up my patient and can see that they don't have on SCD's. I get the " but the Dr. didn't check the little box stating that he wanted SCD's so I didn't put them on speech" even though this nurse put on SCD's a hundred times before for this same surgeon. I tell them that he must have forgotten and to put them on anyway. Most times it's not an issue and the pre-op nurse will put them on based upon my judgement. Every once in a while you'll get a nurse that has to play exactly by the rules and I simply get them and put them on anyway. The pre-op nurse isn't the one in the OR when the surgeon has a fit because there aren't SCD's on his patient. The surgeon isn't going to want to hear that he forgot to write the order or check the little box. He expects me as his surgical RN to know when something isn't right and fix it for him. He can check the little box later.

GadgetRN71, ASN, RN · Jan 30, 2008

Maybe I'm wrong about this but I was always told that you need a MD order for TEDS but not SCD's...also, I've seen nurses just put the SCD's on with no TEDS-some of the old school nurses I know were taught this was wrong, back in the day.

We don't have to have the doc check off a little box or anything, but I've fallen into the habit of asking them when they come in the room anyway. I'd say about 99% want them, especially for elderly, smokers, obese patients or when the case is going to take over an hour. Almost all of our total shoulder/shoulder arthroscopy patients get them. Total hips and knees get them(on the non operative side, naturally) too.

CuttingEdgeRN · Jan 31, 2008

Our preference cards list if the surgeon wants SCDs on, and that's what we go by.

In OP dept, they still only put them on if there's a written order.

I usually work the holding area and I know which surgeons want them and I put them on. (Most do)

Most surgeons have started just usng SCDs, without TEDs. There is supposed to be new literature stating you should use one or the other, NOT both. I haven't actually seen it but most of the younger docs only want SCDs alone durring surgery.

Good or Bad... Us OR nurses seem to not be as worried about the written orders on the chart. We do what we know needs to be done to take care of our patients while in surgery. The doc can write the orders post op.

shodobe · Jan 31, 2008

If the case is longer than 30 minutes we put them on. No need for an order, comes under hospital policy newly put in place.

mcmike55 · Jan 31, 2008

Most of our TED/SCD orders are covered in our pathway orders.

Like you all, we pretty much know who wants what, on what cases.

If the pt is an In Patient, and the floor gets to it ahead of time and puts them on, that's fine with me.

Most of the time, our OutPt area gets the order but doesn't have the staff or time to get them on ahead of time.

I'm ok with that as well, we just do it in pre-op.

Applying TEDS/SCD's are on our pre-op, holding area, notes. We just circle it.

By the way, does anyone have numbers on which is better, thigh highs or knee high TEDs. We've always used thighs, but I've heard it really doesn't matter.

Mike

umakemesmile · Feb 1, 2008

Our preference cards are treated as standing orders. If the card says SCD's, then that is like a written order. As are the med's and equipment on the card.

OR male nurse · Feb 2, 2008

Our preference cards are treated as standing orders. If the card says SCD's, then that is like a written order. As are the med's and equipment on the card.

Ummm.. you should be really careful with that line of thinking that a "preference" card is a standing order and is like a written order. I had a big problem thinking like that when I first came to the OR and adopting that viewpoint. I did some research, and legally, the preference card is not a written order. The problem is that with some preference cards, the patients name isn't on it, it's not dated, and the MD hasn't signed it. You go to your computer and print out the preference card based upon the surgeon and the surgery to be performed. At the last hospital I worked at, we had a seperate sheet for the surgeons orders called "operative order sheet" It had all the little things on there like which local was used, foley, SCD's, dressings, drains, etc, etc. Anything that the RN did for that patient during the surgery that wasn't covered by the pre-op orders. You'd fill out the order sheet during the surgery based upon what care you did, and had the surgeon sign off on it before he left the room. The hospital I work at now has nothing like this, however the preference cards do have the patient name, address, and phone number, so they are patient specific. This holds true only for a scheduled case. If I'm called in for an emergency, I simply print out a generic preference card with no patient specific information. It's one of those gray areas in operative nursing where you have to cover yourself and make sure of what you are doing during the surgery since nothing is written down and is all done verbally.

CuttingEdgeRN · Feb 2, 2008

At the last hospital I worked at, we had a seperate sheet for the surgeons orders called "operative order sheet" It had all the little things on there like which local was used, foley, SCD's, dressings, drains, etc, etc. Anything that the RN did for that patient during the surgery that wasn't covered by the pre-op orders. You'd fill out the order sheet during the surgery based upon what care you did, and had the surgeon sign off on it before he left the room. .

Wow, that's an excellent idea. I never thought about that before....like the heparin or locals we put on the table, the antibiotic in the irrigation and the foley insertion without "wriiten "orders or even a nurse written verbal order. I think I will bring this up to our director. I guess since we have always done the same ole, same ole for all these years, we haven't considered doing this.

shodobe · Feb 2, 2008

Wow, that's an excellent idea. I never thought about that before....like the heparin or locals we put on the table, the antibiotic in the irrigation and the foley insertion without "wriiten "orders or even a nurse written verbal order. I think I will bring this up to our director. I guess since we have always done the same ole, same ole for all these years, we haven't considered doing this.

No, I don't think that is an excellent idea. I think, this is my way of thinking after 30 years, is too many people don't want to take it upon themselves to make decisions that are just logical. I have worked alot of places and to have surgeons sign so-called"orders" after doing a procedure is ridiculous. I agree with another poster that preference cards, that are used in probably 99% of ORs around the country, has an implied meaning. Why would surgeon tell you to "put that on my preference card" if they didn't mean it to be an order that they wanted everytime? G ahead and do what ever you think is the best for you to CYA, but I plan to ask all the surgeons this question, "Do you feel that what is on your preference card is considered a standing order to be performed on all your cases"? I can guarantee you 100% all will yes! I am also going to research this with AORN and other organizations to get a dinifinitive answer.

buck70 · Feb 2, 2008

In my OR, we have standing written orders (a check list). The surgeon signs and dates these orders, and we sign and date them. We check what we have done, and write N/A by the ones that do not apply (or draw a line through the ones that do not apply).