Signing off orders

[Texas77]

I have a question for you other nurses out there. Can unit aides sign off physician orders? At the hospital where I work, we have unit aides (secretaries) that are signing off physician orders. From my previous experience, this is not legal! I need some feedback on this issue.

[NurseKatie08, MSN]

I wouldn't think it's legal, but then I'm not sure because I've never worked in a setting like that. Our unit secretary is a LPN, so there is no issue with her taking or signing off orders. I'd be interested to see what others answer.

[sonja77]

at the hospital i work at now the unit secretary just initials the orders that she puts in the computer (e.g. labs or a diet) and then the nurse that takes care of the pt notes/signs off the orders.

at the hospital that i worked at before two people had to note/sign off orders (usually the unit secretary and the charge nurse). at night when we didn't have a unit secretary it would be two nurses.

[WalkieTalkie, RN]

In my unit they put check marks next to the orders they have entered (labs, x-ray, ekg, etc). However, the nurse is ultimately responsible for signing off the orders, which means that she/he has made sure they were put in the computer system correctly. Techs are absolutely not allowed to do this.

[Flare, ASN, BSN]

I have only ever seen the unit secretary initial to note that the order was entered. When i worked midnights and we had to enter our own orders we also had to initial that they went in, even if we took the order.

[RochesterRN-BSN, BSN, RN]

I've seen the secretaries who are trained take off med orders to a MAR but they have to be checked by an RN...they just do the transcription......then the night shift RN does a second check of all order in the last 24 hours/since last second check.....that was an inpatient psych unit........the medical unit I worked on the nurse would photo copy the order if there was anything the secretary needed to enter into the computer--diet,tests,PT/OT, etc. and then the copy was faxed to the pharmacy for any meds/med changes....then on the original in the chart two nurses had to sign off.....first in black then the second in red...the first could be LPN or RN the second only an RN.

Where I am now the secretaries are not trained and the nurses do it all.....but that is in Psych ER. And we have to have all orders signed by two RNs (not sure about LPN here as we don't have any) and all insulins checked twice--the actual med and a second initial.

[stressgal, RN]

Our unit clerks sign off in black that they entered the orders, the RN signs off in red that they entered or confirmed the orders. Only nurses can use red ink. It amazes me how often a unit clerk will sign off that they entered an order yet when I double check them the order is somehow missing. Honestly if I had the time I would just as soon do it all myself. But time is always the issue isn't it?

[catshowlady]

I have worked at two hospitals. In both places, the unit coordinator enters the orders in the computer (and, in the days of paper MAR's, transcribed med orders to the MAR). S/he signs the orders off as J Smith, UC, etc. in red ink. Then, the RN must review the orders to make sure they are accurately transcribed & entered. Then, s/he signs the orders off J Doe RN, etc. One place has the RN use black ink, the other red. At one hospital, the RN must also do 12hr chart checks at the end of her shift and sign off the chart as such.

The purpose, so I was told, of the red ink was that it would not copy over when the chart is copied in medical records, since UC's are unlicensed personnel.

I was taught that LPN's can only sign off orders that are under their scope of practice; i.e. an LPN can sign off an order for PO Lasix, but not IV Lasix, since LPN's cannot give IV push meds in my state.

[NrsheartTS]

on our unit we have a lady that was a RN in another county, when she came to america she was not able to pass her boards after taking them 4 times, Our hospital allows her to take off MD orders even though she currently still does not have a license

[Christie RN2006]

At my hospital the Unit Clerks will sign off orders in red ink, then a RN has to sign them off and we use black ink. LPNs can take orders that are withing their scope of practice, but an RN has to sign them off.

[Daytonite, BSN, RN]

When someone is signing off a physician's order, they are signing that they have carried out the order. The facility will have a policy that states exactly who can do this. Actually, does it matter who calls the kitchen to see that the patient gets the correct meal? Ultimately, however, facility policy dictates exactly whose final signature must appear on the physician's orders. As a supervisor and manager the policy is what I had to go by. In most all places I worked it was the responsibility of the RN who was assigned to the patient who was responsible for checking and signing off all new physician's orders before leaving. That's who got written up and disciplined for a missed order, not the unit secretary.