Which to follow: MD or Policy?

[Angeljho]

I work part time at an LTC facility. We have a clear policy that states when a patient is transferred to the hospital and stays out of our facility for more than 24 hours, the orders at our facility must be discontinued and new orders written. A returning patient happened to come back on the 25^th hour. The charge nurse told me that the MD didn't want to be bothered with discontinuing and writing new orders since the patient returned just an hour outside of the 24 hour window. She then said she's just going to follow the MDs old/current orders because that's what the MD instructed, and she didn't want to bother herself with transcribing the same exact orders.

Would you follow the policy (which could use some revising IMO) or just follow the MDs current orders?

[eroc]

I would follow orders…unless I saw a contraindication for a new dx. Then I would call the MD if my nursing judgement indicated a clarification.

[DeeAngel]

I would follow policy otherwise there is a risk of being thrown under the bus by the doctor and the facility the second something goes wrong. Trusting people to be stand up people can end very badly if you have not covered your behind.

[morte, LPN, LVN]

Yes, that's the part that was missed from this scenario. After discharge, I wouldn't just take a "resume previous meds" order because that would put the pre-hospitalization meds back on the MAR. You want to put the discharge med rec on the MAR, not the PTA ones.

Which brings me to a different, but related, question. When I discharge anyone, I always put the last dose in hospital date/time, then write when the next dose should be taken for every med on the med rec. I also do that when I discharge a patient back to a nursing home, I include the discharge papers with the big packet of info that the secretary prints out, and I inform the receiving NH RN during report to look for it. I've been told at work by other nurses that they never do that. Isn't that what everyone SHOULD do?

From a nursing home RN, thank you! you don't know how many times we look for that info, and it is no where to be found, or we know it is inaccurate.

[morte, LPN, LVN]

Exactly what I was going to say..[/quote)but this isn't always a safe "default" position.... critical thinking comes in here,....somewhere.....

[drg1984]

If you want to have a bad working relationship with the MD, then by all means insist that they re-write their orders.

Think of this from their perspective - they care less about "policy/administration" and more about just doing their job. They see these kinds of things as a waste of time.

[Angeljho, MSN, NP]

If you want to have a bad working relationship with the MD, then by all means insist that they re-write their orders.

Think of this from their perspective - they care less about "policy/administration" and more about just doing their job. They see these kinds of things as a waste of time.

It may be a waste of time, but I rather a bad working relationship than to risk my license because a MD feels they're wasting their time. Nursing judgement and critical thinking sometimes trump policy, and I wouldn't have minded continuing orders if I was the RN instead. However, I always make sure the MD reviews any transfer documents thoroughly, because you never know what else s/he may "skip" because s/he thinks is a waste of time.