Writing order and having Dr sign later..your thoughts?

mzsuccess · Jul 6, 2018

A discharge med they're unlikely to need tonight doesn't seem like something I would call the on call for.

Right but she's leaving at 0713 and it won't be a nurse in the house to give the med or education about it. We have med techs overnight.

pinkiepieRN · Jul 6, 2018

Right but she's leaving at 0713 and it won't be a nurse in the house to give the med or education about it. We have med techs overnight.

Definitely call a provider if it's a med needed for discharged and they're going to be discharged before seeing someone to write that order!

mzsuccess · Jul 6, 2018

Definitely call a provider if it's a med needed for discharged and they're going to be discharged before seeing someone to write that order!

Thanks..I'm a new nurse and this is one of my biggest struggles. When or when not to call the MD. uGHHH thanks a ton. I spoke to Dr she said to write a v.o

Guest219794 · Jul 6, 2018

I'm currently at work and say the Dr forgot to add something. Do you think its feasible to write out an vo and have the Dr sign later? or call on call? (our on call charge $150 an call) so the nurses really hate using it due to the company trying to save money. The client is D/C and the drug of choice is heron, usually we give narcan kits but the dr usually write an order. Any advice? I know it sounds like a stupid question. But I;m currently the on;y nurse on.

The fact that you are asking must mean that this is a practice where you work. But, as you know, there are rules against making stuff up. So, no, it is not OK to just fabricate an order. (You must already know this.) The fact that nurses actually do this is what keeps the docs and management from creating a protocol that would allow you to take certain actions.

The more calls you make at $150 a shot, the more likely management pushes for reasonable protocols.

mzsuccess · Jul 6, 2018

The fact that you are asking must mean that this is a practice where you work. But, as you know, there are rules against making stuff up. So, no, it is not OK to just fabricate an order. (You must already know this.) The fact that nurses actually do this is what keeps the docs and management from creating a protocol that would allow you to take certain actions.
The more calls you make at $150 a shot, the more likely management pushes for reasonable protocols.

I'm asking because I also work at a LTC facility and I see nurses do this all the time and was just confused and wonder how many nurses actually do it.

caliotter3 · Jul 6, 2018

Most nurses only do this when they know in advance that a certain doctor is ok with the practice. When you do not know that, you take the risk that instead of obtaining the result you are looking for, the doctor instead refuses to "cooperate" and complains to your management. Nurses have lost jobs over this and it is not far fetched to think an employer might report it to the Board. Not worth the risk. Just call the doctor.

Palliative Care, DNP · Jul 6, 2018

I'm not a physician but I can assure you, that I'm not signing any orders that I did not write or discuss. I would also not take kindly to that happening.

AnnieNP, MSN, NP · Jul 6, 2018

I'm not a physician but I can assure you, that I'm not signing any orders that I did not write or discuss. I would also not take kindly to that happening.

I wouldn't sign either!

pinkiepieRN · Jul 6, 2018

Whether you call a doctor or lie about it, an MD still has to sign off on that order within 24 hours for it to be valid, so I'd call someone!

MunoRN, RN · Jul 6, 2018

I'm not a physician but I can assure you, that I'm not signing any orders that I did not write or discuss. I would also not take kindly to that happening.

Normally that's completely reasonable to not be OK with that, but if you're charging $150 per call then I don't think you can really complain when someone avoids making a call.

vampiregirl, BSN, RN · Jul 6, 2018

I would encourage you to get clarification (preferably a reference to a written policy) in case this comes up again in the future. Good for you for catching this need for an order though during the audit process!

Where I work, the only time we write a verbal order without speaking directly to a provider is if we implement a wound care order from our wound care protocol (which is a readily available document that lists specifics for the types of wounds we typically encounter). Otherwise, it is a call to the provider on call if we need it before the next business day.

When I worked LTC, we had a "standing order" set that we could implement PRN orders from to address specific symptoms (nausea, constipation, cough, indigestion etc). There we also entered it as a "verbal" order but these orders were the only ones we implemented without speaking to a provider.

Guest219794 · Jul 6, 2018

I'm asking because I also work at a LTC facility and I see nurses do this all the time and was just confused and wonder how many nurses actually do it.

So, there are really two questions-

1- How common is it?

2- Is it OK?

I think it is pretty common. Especially in the example you gave, in which it is standard to order Narcan kits, and the doc overlooked it. When I worked in the ICU, if somebody had a headache, I might write an order for Tylenol, then get it signed. At least I would with our regular docs in which there was mutual respect. If I there was a jerk covering, or a doc I didn't trust, I would definitely call. At 0200. If he was a real dick, I might give him enough time to fall back to sleep, then call back and explain that we have 325s, and I can't really figure out how to cut 1/13 of a tylenol to make a gram. Covers my butt, provides me some amusement, and helps train the docs. A win all around.

Is it OK? I don't know. Definitely not OK to claim to have a verbal order, unless you have a verbal order. Probably not OK to write any order without a protocol specifying what you do, and how you do it.

Look at it this way- Docs make mistakes. We make mistakes. Everybody makes mistakes. Lets say you fabricate a verbal order, and there is a negative outcome caused by your mistake, do you think the doc is going to sign the order? PT is allergic to Narcan. Says so on the chart, but you made a mistake, and did not check. PT is given Narcan, goes nuts and kills the kid who gave it to him, then dies of an anaphylactic reaction. (Yup, a far fetched, extreme example.) You think Dr Lazypants is going to rush in to validate your lie and take a hit for the team?

We all pick our battles. If you work in an environment that has a culture of doing stuff you think is wrong, or are uncomfortable, you can accept it, try to change it, or leave. I think the least likely to succeed would be to try to change it.