switching orders before doctor approval

[gizzy76]

I'm just curious to know if others have seen this in their practises...

We had a lady come over from the doctors clinic to our outpatient dept with an order for Demerol/Gravol IV to help her migraine (she comes in every couple of days lately) and the nurse I was working with says "I'm not giving this IV, I'm going to give it IM and get Dr so-and-so to change the order later".

I felt kind of uneasy about that. Sure, I would have loved to just have given an injection rather than starting an IV on this lady...but somehow this just didn't seem right.

I realize that yeah, we're in a small hospital and the nurses get to know the doctors very well but...

What's your take on it?

[cannoli]

Well, I wouldn't have done it.

[unknown99, BSN, RN]

never should a physicians order be changed without the physician giving the okay for the change. What would happen if something came from this. Whose butt is the doctor going to cover? Certainly his own, NOT the nurses!!! Besides, if the physician would have wanted it IM, he would have ordered it to be given IM!!!! If the nurse has a concern over the order, she should take it up with the physician.

[nekhismom]

Originally posted by cannoli

Well, I wouldn't have done it.

Neither would I! For one thing, the dosage would need to be recalculated if you change the route, and it may need to be mixed differently, etc. Nope, definately would not have done it!

[SmilingBluEyes]

i would not do this, either.

[kids]

Originally posted by cannoli

Well, I wouldn't have done it.

Ditto.

If I had a valid justification for wanting it I would call the doctor and asked for an order change. I hate to say it but in *my* experience, nurses who do this sort of thing do NOT have a good reason for requesting the change but "know" the doc will sign it after the fact for a lame reason.

[chad75]

I've seen nurses do the same out of pure lazyness. They usually don't write an order though, ie. changing IM phenegran to IV because its easier to give to an immobile patient.

[sjoe]

"If the nurse has a concern over the order, she should take it up with the physician."

Right. This is a violation of the "route" rule, and this nurse is practicing medicine without a license.

(smiling, I love your cosby quote. Wish all nurses lived by it.)

[Nursie30]

I wouldn't for something like that, but I have started a resident on say...Colace or Tylenol or written an order for UA without calling the Dr, small town, Drs have already okay certain items to be written without calling them first, probably isn't illegal, not laziness on my part, but the Drs, they don't want to be called for the little things, but for something like Demerol, yes certainly would bother the doctor to change the order