transcribing orders

[melsmith]

Hi All:

I am newly active on the list, but have been lurking for awhile. I finally decided that I need some input on this issue. When a doctor admits a patient, instead of writing the patient's entire medication list in the chart they write "meds as at home" or "see nursing home list." Then the nurse is supposed to track down a list of meds from home or the nursing home and transcribe them into the hosptial chart. I don't have a lot of experience, but I feel funny about this process and am wondering how common it is. If I have nothing to worry about, that's fine, but I am just looking for a little advice.

Thanks,

Mel

[amyBSN]

At our hospital we refer to those orders as "blanket orders", they are illegal and we are working on educating our doctors about getting away from this practice. If we do have such an order, we get a list of the meds from the patient and we have to call the doctor and go over each med and dosage before we can write the order. I hope this helps.

[mattsmom81]

Our doctors are bad about giving this order too, and unless I can verify the meds by direct RX or find it on a recent discharge summary I am reluctant to take responsibility too.

It is too easy for someone to come up with a 'list', isn't it?

I agree that the doctors are shoving responsibility on the nurses by writing this order, and it makes it difficult...especially after hours. At least during the day the offices can fax lists to facilities.

I've had patients tell me they're on all kinds of drugs at home...even narcs... but how can we be sure if we don't see the RX?? Scary.

I like the term 'blanket order' for this type of thing. To me this is like the doc who writes "Have pt sign consent for....." when they have not yet spoken to the patient.

Too much liability.....

[colleen10]

Eeeekkkssss!!!!

At our hospital for clinical all "at home meds." are d/c and new orders written at admission. No order, no med. All meds. are kept in a locked med. drawer in the patients room. If meds. from home are to be given in the hospital, the patient is not even allowed to bring in the bottle from home and keep it in the med. drawer. Everything must be from the hospitals pharmacy until d/c.

I think it would be too easy for extra meds. to end up on the list or a vital med. to be deleted.

[nursemaa]

Our docs aren't supposed to write "Meds as at home" but they do it anyway. They also write orders like "Have Dr. so-an-so call me", as if we have time to track down Dr. so-and-so to give him the message! Would it kill them to make the call? Then if that doc doesn't call, guess who's fault it is? Another pet peeve of mine is docs who don't bother to read the other doc's progress notes/orders and expect the nurse to take the time to explain everything to them, or re-write the same orders as the other docs, or write orders that directly conflict with the other doc's orders, causing the nurse to make a bazillion phone calls to sort it all out! If the nurse doesn't do that, guess who is considered responsible? AAAGH- doctors!!!

[nursemaa]

OK, I got way off topic-sorry. Actually, I've noticed that alot of patients have become very good about bringing a list of meds that they're on into the hospital with them. If they don't, we ask a family member (if possible) to bring their meds in so we can go over them and check with the doc to verify that he wants them on those meds. I guess the doc can't be expected to remember all of the meds that every patient is on. If it's during the day, the doc's office can usually provide you with a list of the most current meds the patient is supposed to be taking- doesn't help if the patient sees several doctors, though. I don't really know what the answer to this problem is....I wish that all patients would keep a current list of their meds with them, and update it periodically. I usually advise patients and families to do this. As long as you call the doc when you get the list and clarify what he/she wants to order, you should be OK as far as responsibility/liability.

[Pretzlgl]

Originally posted by colleen10

At our hospital for clinical all "at home meds." are d/c and new orders written at admission. No order, no med. All meds. are kept in a locked med. drawer in the patients room. If meds. from home are to be given in the hospital, the patient is not even allowed to bring in the bottle from home and keep it in the med. drawer. Everything must be from the hospitals pharmacy until d/c.

I think it would be too easy for extra meds. to end up on the list or a vital med. to be deleted.

Same at my place. I refuse to take an order like that. I did not go to medical school and won't pile that onto my already overridden workday.

[purplemania, BSN, RN]

This is old-fashioned, creates liability issues for the nurse (MD may later state nurse did not tell them about such and such) and puts pts. at risk. Also does not follow JCAHO guidelines for patient safety goals. We have a form for nurse to write down what patient tells them then MD must read/sign before it becomes an order. If a verbal order is needed we use the same form but state in the call "she is using Lasix" and expect MD to respond with complete orders including route, dose, etc. AND sign order when they are on the floor. The objective is patient safety, not staff/MD convenience.

[Agnus]

I would have to ask the MD what those meds might be.

Meds at home is totally out of line. I am not a mind reader so I have no way of knowing what those are. Additionally asking the patient is totally rediculous since I don't take med orders from patients.

On rare occasions when a pt has transfered to us a Doc has said (over the phone) to continue the meds from the previous facility until he comes in to write more orders. When they do that I go over the meds with the doc. on the spot.

Then I write them as a T/O. That is I write out the specific orders, never do I write to continue meds from previous facility.

When a pt. transfers he must have new orders. Even when they duplicate orders made previously some where else. Anything else is totally illegal.

Many times when a Doc does this he has no clue himself what those meds are. Can you imagine what could result?

To tollerate such plain laziness on the part of the Doc not only put him at risk and the patient it puts you at risk as well. Don't do it.

[Agnus]

this thing about having Doc so and so call me. Is redicilous. We are not his secretarial service. He needs to contact the other Doc himself.

This might seem a bold thing for the nurse to do. The only boldness here is on the part of the Doc assuming you are a secretarial service.

We have dealt with this issue and we do not even allow our unit clerks to provide this free service to the Docs. We tell them politely that they must contact the other Doc themselves that this is something we do not do. And we teach the UC to tell them the same.