Treatments in LTC

NancyJo · May 12, 2005

I haven't worked LTC for a long time, but when I was, most of our treatments were ordered till healed. If they weren't ordered that way then we had to have a Dr.'s order to d/c.

Bird2 · May 12, 2005

I am a fairly new LPN working in LTC and my question is about treatments. Can you d/c the order once a pressure sore is clear or do you need to call the doctor in order to get it d/c'd?

I would call the M.D.'s office to let them know that the ulcer is healed and no longer need the treatment order. Then you can write a dc order.

LPN_mn · May 12, 2005

I have been long term care for 5 years. If it was a nursing order then you don't need a Dr. order to d/c. If it was a Dr. order then you need a Dr. order to d/c unless the order says until healed then you can just d/c tx. Hope that helps.

Bird2 · May 12, 2005

I have been long term care for 5 years. If it was a nursing order then you don't need a Dr. order to d/c. If it was a Dr. order then you need a Dr. order to d/c unless the order says until healed then you can just d/c tx. Hope that helps.

I don't want to appear rude but nurses can not give orders unless they are APN's or Practioners (sp). The Doctor has to be updated on the pts condition anyway so it would be best to at least call his office even if you send a message via his nurse. Then you have covered your own backend.

LPN_mn · May 12, 2005

In Minnesota a nurse can do a nursing order and you do not have to be an

RN to do it at some facilities. Remember we are talking LTC here and not hospital care. Nurses in the hospitals may not be able to do nursing orders but in LTC it is done routinely. We are not working with the acute illness as much as with chronic illness. It really doesn't matter if it was ordered by the DON, A-DON, Supervisor or anyone else it does not need to have Dr. order to D/C unless written by doctor. That is all I am going to say on the subject because I am not going to argue over who can write a nursing order and who can't. I know what I can and cannot do in my state with my license and that is what I was responding to the poster about. Some states may not allow nurses to initiate nursing orders and that is fine but some states do and that is the way I was looking at the questions trying to give the poster an answer.

Schmoo1022 · May 12, 2005

We have most of our treatment orders written "until healed" Then we would just D/C the order. If it was a serious wound or rash I would make the Dr. aware that it was healed.

We have standing orders in our facilty that allows us to write an order, the Dr. still will sign it when he comes to the facility, but we don't need to call him to ask for one the standing orders.

Mostly, these order are for minor issues. ( a small skin tear, obtaining a U/A)

Long Term Care Columnist / Guide · May 12, 2005

Actually, we hospital nurses write nursing orders all the time........they are usually things like frequent VS, preventive skin care, daily weights (you wouldn't believe how many docs forget to order this for their CHF and renal patients), anything that can be done per an RN's judgment.

When I worked LTC, the resident care managers were the ones to decide when to D/C a treatment........the charge nurse or treatment nurse would tell me "So-and-so's pressure ulcer is healed up now", I'd go look at the area to see for myself, then D/C the order if I felt it appropriate to do so. I also D/C'd orders and medications that hadn't been used in a certain time period (usually 60 days); that was part of the 90-day orders in place for each resident, so that we didn't have to call the MD every time someone needed something discontinued. :)

Mandylpn · May 12, 2005

In Minnesota a nurse can do a nursing order and you do not have to be an
RN to do it at some facilities. Remember we are talking LTC here and not hospital care. Nurses in the hospitals may not be able to do nursing orders but in LTC it is done routinely. We are not working with the acute illness as much as with chronic illness. It really doesn't matter if it was ordered by the DON, A-DON, Supervisor or anyone else it does not need to have Dr. order to D/C unless written by doctor. That is all I am going to say on the subject because I am not going to argue over who can write a nursing order and who can't. I know what I can and cannot do in my state with my license and that is what I was responding to the poster about. Some states may not allow nurses to initiate nursing orders and that is fine but some states do and that is the way I was looking at the questions trying to give the poster an answer.

(You are ) correct, I work in LTC myself. We have nursing orders where I work. I think it does depend on the state you live in. :nurse: