SCD orders

[inspir8tion]

Hi:

In my hospital the surgeons are required to write an order before we can place SCDs on a pt/ turn on the machine in the OR.

We have a pre-op check in area for day surgery patients. The doctor admits them to this ward of the hospital and on there they write any orders including "SCDs in the OR". The nurse in that ward signs off on the orders and the pt comes to the OR on another floor and waits in a holding area before being brought into the OR room.

I ask the surgeons to write another order for "B SCDs in the OR" so that I can sign off on it. This pisses a lot of them off. I don't want them mad at me. However, I feel that the OR is a completely different ward than the pre-op check in area. Also, those orders are already signed off by another nurse.

Does anyone have a similar situation and if so, how do you handle this? Do you not request another order and put them on? Do you request another order and put them on? Or do you initial next to the SCD order for the other ward and sign your name, date, time below the nurse for that ward?

Any advice would be appreciated.

Thanks!

[OR male nurse]

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'm sure if I asked all the surgeons where I work they would answer yes also. The point you are missing is that a standing order has to be reviewed and signed off on by the doctor. A master copy of the standing order has to be retained and filed. In your reply you stated how the surgeon says "add that to my preference card." When you change the preference card, it no longer is the same. The surgeon has to go back and re-approve those changes, sign off on the changes, and a new master copy has to be filed if in fact you want to call it a "standing order." We change preference cards depending on the mood of the surgeon. This is the reason the last hospital I worked at went with the surgical order sheet.

[DNRme]

We consider SCD's a nursing intervention, kind of like turning your patients on a schedule or using padding wherever you feel necessary when positioning. Everyone gets them unless there is a specific contraindication.

[Circl8r]

Are you aware that your preference card is as good as a doctor's order? If they are on your preference cards, you are covered and don't have to ask. On another level, check and see if there is a set of indicators in your facility that automatically qualify your patient to wear them as part of venous thrombosis prophylaxis.

[OR male nurse]

Are you aware that your preference card is as good as a doctor's order?

Do you realize this is not true and that a preference card is not as good as a doctor's order. It's simply a list of supplies that he/she might or might not want during an operation depending on past history. It is not a legal standing order.

[shodobe]

Do you realize this is not true and that a preference card is not as good as a doctor's order. It's simply a list of supplies that he/she might or might not want during an operation depending on past history. It is not a legal standing order.

All the nurses and Directors that I have talked to consider this a routine standing order that they want on all cases. Who really cares whether in your opinion it is legal or not. 30 years and not once has this issue ever been brought up, so I think that you are micro picking at an issue that has been around longer than you. So if you want the surgeon to sign everything you do for them or pick for them for each and every case, go for it. I think you reading way too much into this.

[shodobe]

Are you aware that your preference card is as good as a doctor's order? If they are on your preference cards, you are covered and don't have to ask. On another level, check and see if there is a set of indicators in your facility that automatically qualify your patient to wear them as part of venous thrombosis prophylaxis.

Toatlly agree with you on this. Our combined 50+ years of experience leads you to believe this just might be true.

[Circl8r]

Shodobe, thanks for your input and backup! We should oughta know something with 50 years in the OR, eh?

:bowingpur

[OR male nurse]

All the nurses and Directors that I have talked to consider this a routine standing order that they want on all cases. Who really cares whether in your opinion it is legal or not. 30 years and not once has this issue ever been brought up, so I think that you are micro picking at an issue that has been around longer than you. So if you want the surgeon to sign everything you do for them or pick for them for each and every case, go for it. I think you reading way too much into this.

I'm not micro picking at anything. I was merely expressing what I've researched and was told when I asked around about preference cards being a legal standing order. You're the one that brought it up and said it was a standing order. Never said I expect the surgeon to sign everything I do and only related that I've worked at a place that had an intra operative order sheet. It's not like I dreamed it up myself. There must have been an issue somewhere down the line to have an order sheet like that. Who the heck cares if you have 30 years experience that you seem to throw around in your posts like that's supposed to give weight to your rants.

[shodobe]

I'm not micro picking at anything. I was merely expressing what I've researched and was told when I asked around about preference cards being a legal standing order. You're the one that brought it up and said it was a standing order. Never said I expect the surgeon to sign everything I do and only related that I've worked at a place that had an intra operative order sheet. It's not like I dreamed it up myself. There must have been an issue somewhere down the line to have an order sheet like that. Who the heck cares if you have 30 years experience that you seem to throw around in your posts like that's supposed to give weight to your rants.

Well, I am proud of my years and don't make any excuses about it. Please give references to you research and let everybody see the results. I don't hold it against you that you feel that way but you will find that most, if not all, seasoned nurses will not totally agree with you. Maybe I should have said that the preference card was not a standing order, as a written order, but rather a implied order by a surgeon who doesn't want to continue asking why something isn't on their preference card. We have lots of cases where we might mix, give or pour on the field. I certainly am not going to stick an order sheet under the surgeon's nose after a case to have the sign off a med order. Has there then an instance in yout time where a surgeon has questioned why you did something without an order? Just curious, because it seems you have relucdance to do something without the surgeon's expressed written order. If this is your hospital policy then that is OK because you should follow policy wherever you work no matter what you think or feel about it. I have worked many places where things are sometimes done completely opposite with no rhyme or reason. Everybody is entitled to their opinion and it isn't considered a rant. Have a nice day.

[GadgetRN71, ASN, RN]

I also don't think preference cards are just as good as a doctor's order for a few reasons. In my facility, these cards don't always get updated like they should and also, not every patient is the same. Hasn't happened much, but I've had doctors say that they don't want a particular patient to have TEDS or SCDs.(usually severe vascular compromise or skin breakdown on the legs) Out of curiousity, I asked our nurse educator about this topic and the thought that preference cards are as good as a doctors order. She said that it wouldn't be smart to treat a preference card as an order- granted, like I said, most of the time they want SCDs but the circulator should be communicating with the surgeon as far as what a specific patient needs.

Me personally, I don't like the idea of treating an index card covered in some anonymous persons chicken scratch, that is often 5 or more years out of date, as a standing order. I'll be nagging my surgeon because you know what they say about assumptions! PS..and the computerized preference cards aren't much better. We change them and send them to be fixed, and they come back unchanged.

[OR male nurse]

Well, I am proud of my years and don't make any excuses about it. but you will find that most, if not all, seasoned nurses will not totally agree with you. I certainly am not going to stick an order sheet under the surgeon's nose after a case to have the sign off a med order. Has there then an instance in yout time where a surgeon has questioned why you did something without an order? Just curious, because it seems you have relucdance to do something without the surgeon's expressed written order.

You seem to include the fact in almost all of your posts " In my 30 years" like it's the end all to any conversation. We have somebody just like you where I work. No matter what, she throws in the " I've been here 36 years" like it's supposed to end any conversation whatsoever. Nobody listens to her anyway because she's a bitter pill to swallow. Unfortunately I don't think that all seasoned nurses ( with 30 years ? ) will agree with me. However, I'm not going to parade around my department and ask all of them and all of surgeons like you apparently did. I looked this topic up two years ago when I started working at a hospital that required an intra-operative order sheet because, I like you, thought that a preference card was a standing order and couldn't see why we needed that "dumb" sheet. I found out what I related previously and thought I'd share my comments with this forum. I didn't think someone so wise with 30 years experience would have such a negative attitude toward a suggestion as to how god forbid.. someplace else does it. I don't stick a sheet under the surgeons nose after a case. You seem to like to include fantasy in your arguments. If it makes you happy, yes.. imagine me standing in front of the OR door with my hand out like a policeman, pen in hand, shoving a piece of paper in the surgeons face before I'll let him out of the door. Happy now ? Most of the time, you just put the sheet near the door on your prep stand with a pen and they signed it on the way out the door. Quite simple. I also don't have any reluctance to do something without a surgeons order, again your way of putting fantasy into your arguments to build yourself up. If you read my previous posts I for sure do things without the surgeons order and follow the rule of common sense. I'll put SCD's on the patient if the surgeon forgot to check the little box on his pre-op order sheet because I know he wants them and I've said so in my previous posts, I'll clip shave the hairy belly if we're doing a belly procedure in case he forgot to check the little box also because I know he wants me to, and I'll put in a foley for a lap chole in case he forgot to check the little box because I know he wants me to.

[Circl8r]

OR male nurse, is there a reason that you feel that this thread must turn into a pi**ing match, because in my humbly opinionated opinion, that's what it's become. I'm sure that after three whole years in the OR you have a great knowledge base on which to build upon; however, I have found after twenty plus years, that EVERY day in the OR is a learning experience. If you think you know it all and that only your answer is the right one, karma will come back to bite your butt, I guarantee it. For this issue, I don't think there is a right or a wrong, but a 'different'. Different places do different things and it works out fine for them. It never works to shove one's way of thinking down anyone else's throat, whoever is doing the thinking. As long as the end result is safe patient care, that is what matters. We are all in the OR to make sure that our patients are well cared for and and have great outcomes. It is not a place for nurses to have big egos, as we must all work together for the common good...even if we don't agree with colleagues who work with us, or across the country from us.