Standing orders

[PSYCHGIRL]

Need some input from other nurses, please. Our facility has standing orders that we as nurses can utilize for patients. Patient came into the facility, moving out of town and needing medications just enough til see a new doctor at a new location. RN assessed patient and wrote a standing order for her already prescribed meds to be filled for two weeks. Later had the doctor sign the order. Now the doctor is saying she didn't order the narcotic med even thou she signed the medication order. now the facility is reporting RN to board. Isn't the RN covered because the doctor signed the medication order?

[MunoRN, RN]

"Standing Orders" often aren't allowed by regulatory agencies, "protocol orders" are but are sometimes incorrectly called standing orders. Having a standing order for a nurse to prescribe whatever controlled medication a patient self-reports they take is certainly not allowed.

Are you saying a patient could come in, say they're from out of town and that they take 120mg a day of oxycodone and that they need a two week supply before they can actually see a prescriber and have it truly prescribed that an RN there will provide them with that script?

[PSYCHGIRL]

No. the patient had been an established patient at the facility and was already on the medication the RN ordered for her. The RN did not order any new medications , only those the doctor had patient on.

[ruby_jane, BSN, RN]

Wow. I would have been hesitant to continue a script without notifying the doc first but that is my personal practice.

In public health we had protocol orders for TB medication to continue through monthly visits (the nurse did the check up and if nothing was wrong, provided more medication). None of that stuff was controlled, though.

A lot of times we do things for the comfort and convenience of the patient which ultimately backfire because this sounds like it's at the edge or allowable.

[Glycerine82, LPN]

Standing narcotic orders aren't a thing. Pretty sure if the doc is saying they didn't write the order something must have happened. I would never implement such an order even if it did exist, I'd be calling the doc each and every time.

[JKL33]

On 9/1/2019 at 1:30 PM, PSYCHGIRL said:

RN assessed patient and wrote a standing order for her already prescribed meds to be filled for two weeks.

Are you saying that the standing order is something like "RN may authorize 2 weeks' worth of patients' current medications [under x, y, z circumstances]"? Or, as you understand it, what is the "standing order" part of this?

I won't comment on the technicalities/legalities involved, but curious about the rationale under which they are reporting you. Because the physician signed something s/he didn't look at and is now disappointed that it included a controlled substance? Or did their policy specify that controlled substances were not to be included in [their idea of this type of] "standing orders"?

Overall this doesn't sound like a good procedure, and if you haven't been terminated already this is your notice to stop following this procedure and to stop any involvement in orders this physician doesn't write him/herself or at the very least sign in real time.

Kind of a mess and if they are going to report you then it may be worth it to have legal counsel advise you how to handle BON interaction.

[PSYCHGIRL]

Yes. it was the above, may authorize two weeks meds patient already on. Doctor signed the order but then backtracked and said she didn't mean to sign for the narcotic. Yeah. Lesson learned. I don't even want to take verbal or telephone orders either anymore after this experience.

[Oldmahubbard]

Sounds like a good way to get thrown under the bus

[kp2016]

Take a deep breath. It’s a hot mess but it will be ok. You followed their established policy, quietly get a written copy of that policy if you can. The Doctor already signed the order so you are covered, there is no taking back a signed order after it is completed.

Obviously I would not say another word to anyone about this without a lawyer. I would also be looking for somewhere else to work ASAP. Your current unit is vicious.

[Dragonnurse1, ASN, RN]

Given the current policies regarding any narcotic prescription this entire situation is a mess. All physicians must now justify every narcotic order every time one is written. With the DEA, FDA and CDC breathing down the neck of physicians, pharmacists and patients we are treading lightly or running scared as hell. Physicians that are NOT pain management are restricted in their writing of narcotics and as a result many are refusing to write for narcotics under any condition. Pharmacists are now allowed to refuse to fill valid prescriptions. Physicians must document each RX written and justify the dose and number of pills the patient requires.

The physician may have forgotten to do their documentation for that specific script and is throwing the RN under the bus to avoid responsibility.

[murseman24, MSN, CRNA]

On 9/7/2019 at 3:59 AM, Glycerine82 said:

Pretty sure if the doc is saying they didn't write the order something must have happened.

Yeah, they just signed the order without paying attention to it and are now throwing the nurse under the bus to save their own ***.