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Standing orders

Medications   (329 Views 9 Comments)
by PSYCHGIRL PSYCHGIRL (New Member) New Member

PSYCHGIRL has 25 years experience .

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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? 

 

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MunoRN has 10 years experience as a RN and specializes in Critical Care.

6,235 Posts; 64,611 Profile Views

"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?

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PSYCHGIRL has 25 years experience.

4 Posts; 107 Profile Views

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

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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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.

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Glycerine82 has 3 years experience as a ASN, LPN and specializes in SNF/Rehab/Geri.

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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. 

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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.

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PSYCHGIRL has 25 years experience.

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yes. it was the above, may authorize two weeks meds patient already on. Doctor signed the order but then backtracked and said she didnt mean to sign for the narcotic.  Yeah. Lesson learned. I dont even want to take verbal or telephone orders either anymore after this experience. 

 

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kp2016 has 20 years experience.

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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.

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