Writing orders

[welch07]

Hi I am new to HH. My back ground is med surg in a hosp and have been a rn for well over 5 yrs. my question is writing home health doctors orders is a little different than what I do in te hosp. Any one have any advice about how etc? Thank you

[Holisticlifern]

I'm new to home health as well. Just last week I had to write orders for the first time. I just looked in the patients chart at old orders and used it as a template. It was a fairly simple order, I will give an example. I made a visit to check an INR, called the office and was told to have the patient take a certain dose for x/days, etc. here's how I did it

dx: afib

Summary: INR 2.0 md office notified. PT instructed to take 4mg Coumadin every night starting 4/11 until 4/13. PT verbalized understanding of medication order

order: 4mg Coumadin every night starting 4/11 until 4/13. INR to be rechecked 4/14

to sign the order my office just rights the TVO by dr. Whoever (telephone verbal order)

Hope this helps

[toomuchbaloney]

Back to Basics: Physician's Orders

We required that orders were directly related back to problems or dx listed on the POC within the order themselves.

[welch07]

Thank you. I feel it will just take a little to get use to.

[KelRN215, BSN, RN]

Are you talking about 485 orders or interim orders?

[welch07]

All of them. 485 mostly

[KelRN215, BSN, RN]

Ok, so the 485 is your plan of care. When you do the admission assessment, you make a plan for the patient, do you not? That's your 485.

[welch07]

I just did my first admission yesterday. See I have had no real training in this so I am learning as I go. Slow but sure I am learning lol

[KelRN215, BSN, RN]

You have no training at all? Are you working per diem or full-time? I don't think the writing orders/building the 485 requires a TON of training but you should have some...

[sadnursemg]

I wont mention the name of the homecare company that i work for but I will simply say this. Be sure that your manager can't change your orders. My boss changes our orders on a regular basis. I finally told her about a week ago that what she was doing was not legal. she deleted the name of the physician that i spoke to and the date and time that i spoke to them. It was a total power trip. So the orders went to another physician in the practice. what a mess. So with that said. Homecare orders are the same as hospital orders but they should be related to the 485. In a hospital you would simply get a dc order right. In home care the dc order should say something like all goals met plan to dc on....date. Coumadin orders should also have the reason for the test included in the order. for example s/p hip replacement...you would benefit from having a point nurse that you can bounce things off of in the field. My guess is that like most companies they are cutting back on orientation. My orientation consisted of being handed a small computer and I was told to 'go play with it' that was it. I had no idea what i was doing for the first three months. i kept getting called into the office because i missed this step...or that step...it was a total lack of orientation to the device. be sure you get a proper orientation. Good luck!

[sadnursemg]

Also in homecare...please remember that you can not take orders from the patient. You can get into a lot of trouble doing that.

[welch07]

Sadnursemg that is basically what has happened to me. Here is ur comp have fun. One nurse I will text to ask questions but she never text back. The other is to fast she likes to talk but by end of conversation my question was not answered. So I have been learning this on my own. I am hoping to sit with the Q A nurse this week and get answers to my questions. For now I'm sticking with just skilled visits. And yes I am per diem at this place. Main job is med surg at a hosp b