What orders can an LPN write?

[nuebelpn]

I am a new LPN just starting out in LTC. This is my first nursing job ever. My orientation was not very long and then I was

let out on my own. I am a little confused about what orders we are allowed to write? Do LPN's write all of the treatment orders

or do the doctor's write the more invasive ones? And with meds, is it OK for the LPN's to write orders for things like cough medicine

and anti-diarrhea medications? Whenever I ask another seasoned nurse one of these questions, they look at me like I should already

know this. I am not afraid to ask questions, but I am not getting answers. Please help me get some clarity.

[Sparrowhawk]

Depends on what standing orders the doctor has at your facility...if he/she has standing orders for those things LPNs can write whatever order the RN can....if they don't, you can't just write an order without a doctor's order

[mamamerlee, LPN]

Ask your manager, and find the policy manual. Ask where the lists of standing orders are kept. People look at you funny because they are probably unsure themselves, and you have stumped them!

[ettac]

Hi, you must call the doctor and tell them Mrs. so and so is coughing. If the doctor orders a cough med, you then write the order and sign it; T.O. Dr.____/your name, LPN. When the doctor makes rounds they must sign all of these orders.

You can not just decide someone needs a medication and write an order without contacting the doctor first.

[nuebelpn]

There are some standing orders for things such as Tylenol for pain or fever, MOM, enemas, etc.

I have seen nurses write orders for OTC cough medicine without first calling dr. I had a resident ask for a throat lozenge. Do I really need to call dr for something like this?

[kathy313]

In an ltc there are usually standing orders, check the resident chart, the last place I worked at, the standing orders were placed before the med sheets. Some diabetic residents have standing orders r/t parmeters, some hospice residents also have their own. Take few extra minutes and get familiar with the charts, see where everything is. Many times the standing orders are printed on the MAR under PRN meds.

And ask, even seasoned nurses ask questions. I'd be afraid of the nurse that never asked anything! New nurses aren't expected to know everything.

And for the most part, we are physician directed. Check your house policy, the doc can give an order verbally, you're responsible for writing it up, sending it to pharmacy, putting it in the med or treatment book.....blah, blah, blah...lol!

[ettac]

Unfortunately LTC is the most regulated industry in the nation. I was DNS at one for 7 years and every T must be crossed and i dotted, or the state inspectors will eat your lunch. I was told that standing orders are not legal (maybe states are different?) so we wrote every conceivable OTC as a prn on admission orders. This covers 90% of what you have to call the doctor for. Otherwise, I would call. Better safe than sorry.

[lifetimern]

There are some standing orders for things such as Tylenol for pain or fever, MOM, enemas, etc.

I have seen nurses write orders for OTC cough medicine without first calling dr. I had a resident ask for a throat lozenge. Do I really need to call dr for something like this?

Here's the low down:

You can utilize standing orders as you would any conventional order.

You can accept and utilize verbal or telephone orders per your facility's policy and procedure. Remember to read back and verify the order with the provider and note it on the order form.

Some nurses will write orders without contacting the doctor. Usually these orders are for medications or procedures the nurse feels are 100 percent obvious given the situation. Also, these orders are often written to save time or make life easier for the doctor/nurse/patient. This behavior is not uncommon, but it is illegal. If something goes wrong or a mistake is made, you have no legal leg to stand on. Experienced nurses (and some patients) may become irritated because it takes longer to call the doctor and get an order, but you need to be concerned with protecting your license and insuring patient safety by following the usual standard of care.

The reality is that there may someday be a reason for you to write an order on your own, but, especially as a novice nurse, it would be terribly unsafe.

[Sparrowhawk]

There are some standing orders for things such as Tylenol for pain or fever, MOM, enemas, etc.

I have seen nurses write orders for OTC cough medicine without first calling dr. I had a resident ask for a throat lozenge. Do I really need to call dr for something like this?

Is a throat lozenge technically a drug? Now I'm confused.

[lifetimern]

A throat lozenge is a medication, and it requires an order.

[kathy313]

"Is a throat lozenge technically a drug? Now I'm confused."

Lol...isn't that crazy? I actually did have to get an approval from the doc for that before, not sure if it was house policy or what, just went and did it.

[Sparrowhawk]

weird..you'd think throat lozenges wouldn't be a drug...