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.

[HmarieD]

Good rule of thumb.. if it says "keep out of reach of children", it's a drug.

In my State (IL) LPN's can write orders for everything EXCEPT medication, under the direction of a physician, of course. You should check your state's nurse practice act.

[Cat_RN, ASN, BSN, RN]

It also depends on the doctor.. some doctors don't want to be called for certain things, they'll just sign it once it's written. One of the doc's for most of my pt's s is ok with things like PRN o2, small dressings, most PRN OTC's like MOM or breathing tx's for people who have hx. of asthma or COPD, also right down to CXR's if someone has a cough and sounds crackly. (Of course you'd call with results and patient condition, but get the CXR started since you know it will be ordered). It really depends on the doc and patient. Before you do anything, ask an experience nurse or manager who you trust. Don't do anything you're not comfortable with! Last night I wrote something for Duo-neb for a guy with COPD/asthma who's needed them twice during the night but didn't have a current order for PRN tx's. Of course I gave it to him regardless as I'm not going to let him get really bad in respiratory distress, and he used to have an order for PRN's but they changed his scheduled tx's to more during the day but none at night. Doc will be notified and his condition will be tracked of course. I also wrote an order for transparent dressing for an excoriated area on a buttock because patient had diarrhea and I didn't want it to eat away at an already compromised area. Common sense things like that.

I dont think anything is wrong with necessities like that, doc's are busy and don't want to be called for every little thign. Use your judgement and ask before you do anything! That's what I do, as I too am still new. :)

[Cat_RN, ASN, BSN, RN]

It also depends on the doctor.. some doctors don't want to be called for certain things, they'll just sign it once it's written. One of the doc's for most of my pt's s is ok with things like PRN o2, small dressings, most PRN OTC's like MOM or breathing tx's for people who have hx. of asthma or COPD, also right down to CXR's if someone has a cough and sounds crackly. (Of course you'd call with results and patient condition, but get the CXR started since you know it will be ordered). It really depends on the doc and patient. Before you do anything, ask an experience nurse or manager who you trust. Don't do anything you're not comfortable with! Last night I wrote something for Duo-neb for a guy with COPD/asthma who's needed them twice during the night but didn't have a current order for PRN tx's. Of course I gave it to him regardless as I'm not going to let him get really bad in respiratory distress, and he used to have an order for PRN's but they changed his scheduled tx's to more during the day but none at night. Doc will be notified and his condition will be tracked of course. I also wrote an order for transparent dressing for an excoriated area on a buttock because patient had diarrhea and I didn't want it to eat away at an already compromised area. Common sense things like that.

I dont think anything is wrong with necessities like that, doc's are busy and don't want to be called for every little thign. Use your judgement and ask before you do anything! That's what I do, as I too am still new. :)

I take back the 'most PRN OTC's'. Not most, but quite a few. Especially if they are simple ones like artificial tears or saline nose sprays.. etc. I wouldn't write an order for anything 'bigger' than that.

[kcochrane]

Check your hospital policy for telephone orders too. At my facility, LPNs are not allowed to take telephone orders.

[nursinger]

At my facility LPN's are not allowed to write orders of any kind.

[Finallydidit]

At my facility each Dr. has his/her list of standing orders along with protocals as to when we can utilize them. We do not give our residents cough drops or throat lozenges as they present a choking hazard for the elderly and confused. If we give a standing order med, we have to write the order as a telephone order, and write it in the MAR, and document document document, but they are really nice to have. LPNs can write what ever an RN can write, even the CXRs. I would bet at your facility, there is a notebook with standing orders in it, ask your DON and take a look at it.

[supernurse1230]

if your facility has whats called "standing orders" then you can write up that particular order for whatever your needing, like tylenol, immod, mom, etc, but if your facility does not have standing orders, then you will need a order from that residents doctor for anything they might need, some places will say, "oh, dr X doesnt care if you write that order for tylenol", but unless you kno this to be a personal fact, then you should still call to get an order, even basic treatment orders can be written up by a nurse, for instance if someone gets a little cut, of course you would complete an incident form, but when you notify the doctor, inform him of what first aid you provided, and unless he orders something further, then what ever you did ex (clean cut to rt arm with ns, apply tao, and cover with bandaid qd until healed), is your order, the doctor really just "ok'd" your suggestion, but, he also gave you a verbal order, hope this helps and i didnt confuse you, good luck

[supernurse1230]

what kind of place is this i need to apply there, lol