Taking floor orders in the ED?

[sorefeet]

I was just wondering how many of you have to take admitting orders from the admitting MD (via phone) for the floor and if you do---what is your process.

[bill4745, RN]

We do, and we hate it. We have brought up the concept "verbal orders only in an emergency" - is admitting a stable M/S patient an emergency? The big problem is meds -"write for whatever they say they are on- I don't have time for you to read them all to me" says the doc.

[TRAMA1RN]

We do, we have fought against this for 7 years. Some of our ER docs help though by saying to the admitting "OK, we will have the floor call you for oders, and then hangs up"

[pkapple]

This is a problem everywhere! One ER I worked at had a pretty good system. The ER doc would write basic admit orders-and i mean basic;

Admit to sleepy doc

DX:whatever

routine vs,activity and diet(either BR/NPO or as tol)

continue iv fluid (if running)

O2(if in use)

call sleepy doc on arrival to floor

Only problem with it was sleepy doc didn't want to wait an hour for floor to accept patient and call, so would try to call orders to floor and of course they know nothing so would call ER to give the orders--can't win!!!

[RunnerRN, BSN, RN]

We do it much the same way that pkapple does. The admitting doc has the option of coming down to the ED (or sending a resident) to do an admitting assess and write orders. If they don't get there before the room is ready and the pt is going up, the ER doc will write basic orders (we have a basic orders sheet, so it is generally just circling) and send the pt up. We also have several hospitalist teams, and many patients are admitted to them. If that is the case, then no orders are written.

The only big problem we run into is if the admitting doc/resident is there when we are waiting on transport to the floor. With the high number of patients we have, I don't hold a bed for anyone :) even a doc!

[Tweety, BSN, RN]

Patients don't come to the floor without admitting orders. The floors rarely have to call the doc for further orders. They are written by the ER doc, usually in consult with the admitting physician, but sometimes the nurse will take the call if the doc is busy. Usually just basic orders to get them to the floor like diet, activitiy, meds. This gets the patient to the floor and out of the ER. There's usually an expiration time on the ER admit orders 8 to 24 hours by then the doc hopefully has arrived to the floor to write further orders.

The exception are the trauma patients, stroke patients whose symptoms started at a known time, and MI's. These patients are seen by the admitting doc (or in the case of the strokes and MI's those are usually consulting docs, but the neuro and cardiac docs write the orders) in the ER within a certain time of their arrival in the ER and orders are written.

It seems to work for us.

[gonzo1, ASN, RN]

Our ER docs often write basic orders. Sometimes when the ER doc calls the admitting they will want to give orders, so any nurse passing by at that time has to stop and talk to the admitting doc on the phone and take the orders. The problem with that is if it is not your patient you don't know anything about them and might miss asking for appropriate orders because of that. So I hate it when I'm "it".

Lately, since our ER got so big most pts are going to the floor with basic orders that say for the floor to call the doc.

[TazziRN, RN]

It rarely happens, since the ER doc usually writes covering orders and the other times the admitting doc will come in and see the pt. When it does happen, though, it's usually just basic orders to get things started and the doc comes in later to write more detailed ones. We don't mind taking the phone orders for admits because it's the difference between getting the pt to the floor within an hour and waiting for hours because the ER doc's too busy to write covering orders.

[neneRN, BSN, RN]

Our ER docs do not write any orders for the floor at all. Most admitting docs want to give floor orders once they're done talking to the ER doc, and the phone and chart get passed to the charge RN. Charge takes all admitting orders. Admitting docs like it because they talk to the same handful of nurses every time they give orders and ER docs like it because the charge desk is right next to the docs' area and they don't have to hunt down the primary nurse. Charge nurses hate it because they don't know the pt and have to dig through the chart for Hx, VS, labs, meds given, etc. Also, our ER is separated into critical care and intermediate care with separate charge RNs for each side...so on the CC side, where we can have up to 40 pts with 80%of those being admitted, this process sucks up a lot of the CN's time.

[mamalle]

we take the orders all the time via telephone. its your patient and you do it. never known another way around it. sometimes if Im super busy I will have a nurse that can take them but otherwise- we all do our own.

[floatRN]

Where I work, ER patients always come to the floor with orders already written. They are not even supposed to call report to the floor until orders have been written. If the patient doesn't have a primary care doctor, then a hospitalist sees the patient in the ER and writes the admission orders.

[queenpurplern]

we have to do it also, and we all feel not only is it a waste of our time but its so inappropriate for us to take the orders when we will not be implementing them on the floor:nono: . especially when the pts come in from snf, with a 5 page list of meds and the doctor says just read them and ill say yes or no,, well we have to rewrite all of it and its too time consuming...:angryfire