We have this med order

UM Review RN, ASN, RN · Mar 17, 2005

Sounds like this is a good issue to come up for discussion at the patient's Care Plan Meeting.

Blackcat99 · Mar 17, 2005

If the patient is alert and oriented she should decide if she wants to take the med or not. If this is a confused and disoriented elderly lady in LTC and the husband has power of attorney then don't give it. At the LTC where I use to work the doctors would usually discontinue meds the family requested to have discontinued. I'm curious. Which medication is it?

GLORIAmunchkin72 · Mar 17, 2005

We have all kinds of little "stickeys" on our MAR, and God forbid you overlook one of them....

Sounds like this is a good issue to come up for discussion at the patient's Care Plan Meeting.

alanpe · Mar 17, 2005

No med order is today a big problem.

Thanks to internet and new technologies many patients can learn about his pathology more than a doc; the doc has two responsabilites on the prescription:

the illness people.

the comunity.

Many drugs are very expensive, society must administrate its resources; doc and nurses are in this way civil servants and must care not only the illness people. The comunity is important.

GLORIAmunchkin72 · Mar 17, 2005

suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?

No med order is today a big problem.
Thanks to internet and new technologies many patients can learn about his pathology more than a doc; the doc has two responsabilites on the prescription:
the illness people.
the comunity.
Many drugs are very expensive, society must administrate its resources; doc and nurses are in this way civil servants and must care not only the illness people. The comunity is important.

~Kitty~ · Mar 17, 2005

A little piece of paper can fall off at any given time. We have to constantly circle our initials and chart on the back of the MAR the husband's request. This can get tiring and we have a lot of meds to give.

suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?

You said you are documenting appropriately. You are right to document husband's refusal on the MAR. I don't believe "stickies" are valid documents. ;-)

I also am curious why the doc won't change it??? What a hassle to have to document daily refusal.

GLORIAmunchkin72 · Mar 17, 2005

why the doctor's sometimes refuse to change the orders. Maybe they just have so much to do that if they don't think it's a life and death situation they just let it ride. Sometimes we have veritable tag of wars between the families, the doctors and the hospice nurses. I am the little guy stuck in the middle.

You said you are documenting appropriately. You are right to document husband's refusal on the MAR. I don't believe "stickies" are valid documents. ;-)
I also am curious why the doc won't change it??? What a hassle to have to document daily refusal.

suzanne4, RN · Mar 17, 2005

A "sticky" is not a legal document in a court of law. If the order is there, and not given, it must be documented as to why it is being held on a daily basis.

Simple as that................

Has the husband discussed his reasons for why he only wants the drug given once a day with the physician? If not, perhaps this should be your next step..

barefootlady, ADN, RN · Mar 17, 2005

It's time for the patients family, doctor, DON, and administrator to sit down in a meeting and iron this situation out. It is also time for the nurses(more than one) to approach the doctor. They need to make him understand that their hands are being tied by the family, then chart this in patients chart. It does need to be charted everyday that family refuses to allow med BID. We can say we are too busy, but in the end we still have to follow safe practice guideline to protect our license.

alanpe · Mar 18, 2005

suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?

A sticky is not a valid document to do.

alanpe · Mar 18, 2005

suppose you're in a court setting and they ask why you withheld so and so's meds for such and such period of time, then you tell them: the "sticky" said to. And they say, "what sticky?" (the sticky is long gone, fallen off or something...), are you following me? Is a "sticky" a valid document in court? Shouldn't there be a place on the MAR where you record, date and sign these temporary changes and those requesting the changes despite the doctor's orders should also sign their full name and initials. Am I being just too picky?

You will need the order, always the order. The sticky is not enough