Inappropriate orders

[Lostin_space]

What to do when nursing staff put orders under your name that were not authorized? This is clearly a medico legal issue. Who do I report it to?

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[ProfMD]

I would talk to the attending involved in the patient's care first.

 

[Lostin_space]

I would talk to the attending involved in the patient's care first.

Ok, and then what? These were electronic orders. I won't be signing them. Isn't it illegal for nursing staff to do that?

 

[ProfMD]

Ok, and then what? These were electronic orders. I won't be signing them. Isn't it illegal for nursing staff to do that?

Yes it is.

Don't sign them. Talk to the attending. There are likely institutional rules in place and none of us can tell you exactly what to do. However, the intending is ultimately responsible for all that goes on with a patient and needs to know before anything else is done.

One thing to consider, though - is it possible that someone else gave a verbal order and it was just assigned to the wrong physician?

 

[Ismet]

Ok, and then what? These were electronic orders. I won't be signing them. Isn't it illegal for nursing staff to do that?

The attending can talk to the nurse manager and address the issue.

Nurses can put in some orders under our names if we give a verbal order. Usually for us it's orders for super special flush syringes that I can never find to order myself.

 

[Lostin_space]

The attending can talk to the nurse manager and address the issue.

Nurses can put in some orders under our names if we give a verbal order. Usually for us it's orders for super special flush syringes that I can never find to order myself.

Right I don't mind verbal orders. But orders were placed as stat for a patient when I was not even in the hospital. It's not like they talked to me about it and I said ok. They just placed them without even asking.

 

[Promethean]

Tread carefully. If one nurse did this, consider talking to them first, to see if it was just an error. Or do as suggested and speak with your attending. That will give you a better sense of the culture and protocols at your institution and maybe spare you some trouble.

While there are some practices which are not entirely medicolegally ideal, but are never-the-less the standard practice at a given facility. If this is one nurse who overstepped, and if the order was for something potentially dangerous for the patient, that is one thing. But if it is common practice at this place to avoid paging in order to get those innumerable, trivial orders for things like PT/OT consults or other routine things like that... Look, I'm not saying it is right, but that is just how a lot of places run.

Especially when the physicians and nurses know each other well, often the latter put the orders in and tell the docs later what they did. Yes, that is outside the nursing scope of practice. But it is still the way a lot of places operate. I'm not saying that you shouldn't challenge that, even if it is the way things are usually done there. If you feel it is unsafe and don't want your name on it... well, there is a right way to go about it.

 

[rokshana]

Right I don't mind verbal orders. But orders were placed as stat for a patient when I was not even in the hospital. It's not like they talked to me about it and I said ok. They just placed them without even asking.

you should double check to see if it was just an accident...happens all the time (especially in the days of paper notes/orders) orders need to be placed and they put it under the last person they have a note from...usually the one that has a legible signature...

since its an electronic order, reject it and they will have to find the real person...then let your attending know about it.

 

[ssttrrbbk]

you should double check to see if it was just an accident...happens all the time (especially in the days of paper notes/orders) orders need to be placed and they put it under the last person they have a note from...usually the one that has a legible signature...

since its an electronic order, reject it and they will have to find the real person...then let your attending know about it.

-Yes a lot of time its a verbal order and they don't remember who was actually there. I reject it and it gets sent back to the person .

 

[Lostin_space]

-Yes a lot of time its a verbal order and they don't remember who was actually there. I reject it and it gets sent back to the person .

thats different. a verbal order is fine - this was not even discussed with me

 

[ssttrrbbk]

thats different. a verbal order is fine - this was not even discussed with me

yes it was probably a verbal order from someone else. If you are on the rotation they may have thought it was you and assigned you. Its also possible your name is close in spelling to someone else and it got entered in the system wrong. I just reject it and send it back to the person who sent it to me to sign. Thats what everyone in my residency did. I got quite a few of these. I doubt the person is trying to do this to you.

My last name was the same as an attending and I constantly got wrong orders. I'm not sure if its really something that needs reported unless you really think that something wrong happened that shouldn't happen again. If that's the case talk to the nurse manager.

 

[Smurfette]

If you think the RN put an order in your name but was inappropriately 'playing doctor', it should be reported to their superviser (talk to your attending first to see if they agree it was inappropriate). This is pretty unlikely, but if you have concerns, you should address it.

If the order was just put under the wrong doctor's name (i.e. another doctor gave a verbal order but the nurse entered it under your name accidentally), refuse the co-sign request and let the medical records dept sort it out. It happens pretty frequently and isn't a big deal. Especially with stat orders when the SHTF, they may be trying to get the orders in quickly and picked the wrong physician.

 

[Siggy]

If it's reasonable (especially if I was involved in the case), then I'll sign it. For example, pharmacy normally talks to someone about switching IV to PO antibiotics and then files it under someone random who is on the chart.

However, if it's a stupid order, I won't sign it. For example, it's "policy" (yet no one has a copy of the policy) for everyone with "diarrhea" (which most of the time is loose stools than actual diarrhea) gets a C. diff checked. Yep... no... who ever put that policy in place should be the cosigner. Or there was the, "The ER doc wanted this order in, and it got told to the floor nurse who filed it under your name..." which happened for a TB workup for a patient with no signs of TB, a negative CXR, but a history of TB. Yep... not signing that one either.

 

[TooMuchResearch]

thats different. a verbal order is fine - this was not even discussed with me

Our surgical ICU nurses place verbal orders all the time when they know it's for stuff we won't question.

Sometimes they even do it under the wrong person. I usually just sign it anyway. It's the unit culture.

They're not ordering anything particularly dangerous though.

When they restart a pressor or sedative/analgesic "because it was still in the room," a bit more discussion is in order. Then again, some used to work in units where they verbal ordered and titrated drips at night without involving the physician.

The point is, these things vary quite a bit from place to place.

 

[gutonc]

you should double check to see if it was just an accident...happens all the time (especially in the days of paper notes/orders) orders need to be placed and they put it under the last person they have a note from...usually the one that has a legible signature...

since its an electronic order, reject it and they will have to find the real person...then let your attending know about it.

This is most likely what happened. Just reject it and let somebody else deal with it.

If it's something that happens a lot, bring it up with your attending.

You (OP) have a tendency to think everything that happens is some sort of direct assault on your liberty as a physician and you seem to only consider the nuclear option. Consider chilling the F out every now and again. It will make your life much better.

 

[Lostin_space]

This is most likely what happened. Just reject it and let somebody else deal with it.

If it's something that happens a lot, bring it up with your attending.

You (OP) have a tendency to think everything that happens is some sort of direct assault on your liberty as a physician and you seem to only consider the nuclear option. Consider chilling the F out every now and again. It will make your life much better.

No, see that's the extremely interesting thing. I typically let a ton of things slide. I recently had a discussion with a mentor and was telling him how the opposite seems to be the case. So in our discussion I was discussing my experience with me letting a ton of things slide for other people - for example, both of my under level residents not finishing work on time, not doing admissions correctly, not following up on plans, putting in wrong orders, forgetting to write notes, etc. etc. I typically just correct the mistakes and move on. But when it comes to me, it seems that the "nuclear" option is used. I got yelled by an intern!! twice - same intern who yelled at one of our PGY4 residents as well - and I also got yelled at by an ENT resident who did not want to come in on call for an airway issue. did I report them? No. Did I make a big fuss out of all the countless mistakes my residents made? No. Did I report my fellow peers whose numerous admissions I had to fix (and I have the emails from administrators saying things need to be corrected - I just went ahead and did it.)

I think this is a normal process of every day life. But when I make any mistake, or even things that are not mistakes, I get royally royally screwed. Examples - I did an admission recently where I mistakenly picked the wrong attending for co-signature. I corrected my mistake, and what not, no issues occurred, managed patient well, everthing was fine. But one of the lower level residents makes it their business to behave as if I've done some mortal mistake and goes specifically and tells such said attending (who was already aware of the issue) over the weekend! about this unforgivable mistake. Or apparently I had wrinkled pants one day - I got labelled as routinely looking dishelved which was put on an eval, and my advisor had to discuss it with me. They even go as far as saying - they are aware that they have never seen me looking messed up but it's somehow become an "issue." Or I got paged countless times during my vacation - I was out for a week - clearly I'm not going to answer my pager when I'm not on clinical duties. I got labelled as a non- pager responder - which is a "problem" - even though I have not made it an issue until recently that nursing staff and therapists don't answer their phones/pagers on a regular basis.

The issue is - perhaps I'm not likeable in this setting, which is odd because in previous settings I have been called "pleasant, sweet, gentle" etc. So people try to make big issues out of nothing. I even told my advisor recently - I feel ridiculous having to run to the chief about every single little thing out of fear that there will be some negative outcome out of things that should not be. The response was that I should still do so so that they could "take care of things."

Why is it that I can let things slide right and left but everything I do is a mortal sin?

Why is it that out of the 10 nursing evals that I have from my most recent rotation, 8 of them are 3-4/4 and 2 are not good. Clearly I can't be that hateable and terrible if most of the staff is fine with my work, attendings were extremely happy with my work, patients were well taken care of.

So there is some issue - that no one is willing to address - that cannot really be resolved. I'm more than happy to have an honest conversation with people to try to resolve things - but it doesn't seem like most things in certain environments want a resolution. Many other residents have had the same experience in the rotation. So when there are repetitive problems it typically is a 2 body problem. If only one body is "dealt with" the problem is bound to recur.

 

[ProfMD]

No, see that's the extremely interesting thing. I typically let a ton of things slide. I recently had a discussion with a mentor and was telling him how the opposite seems to be the case. So in our discussion I was discussing my experience with me letting a ton of things slide for other people - for example, both of my under level residents not finishing work on time, not doing admissions correctly, not following up on plans, putting in wrong orders, forgetting to write notes, etc. etc. I typically just correct the mistakes and move on. But when it comes to me, it seems that the "nuclear" option is used. I got yelled by an intern!! twice - same intern who yelled at one of our PGY4 residents as well - and I also got yelled at by an ENT resident who did not want to come in on call for an airway issue. did I report them? No. Did I make a big fuss out of all the countless mistakes my residents made? No. Did I report my fellow peers whose numerous admissions I had to fix (and I have the emails from administrators saying things need to be corrected - I just went ahead and did it.)

I think this is a normal process of every day life. But when I make any mistake, or even things that are not mistakes, I get royally royally screwed. Examples - I did an admission recently where I mistakenly picked the wrong attending for co-signature. I corrected my mistake, and what not, no issues occurred, managed patient well, everthing was fine. But one of the lower level residents makes it their business to behave as if I've done some mortal mistake and goes specifically and tells such said attending (who was already aware of the issue) over the weekend! about this unforgivable mistake. Or apparently I had wrinkled pants one day - I got labelled as routinely looking dishelved which was put on an eval, and my advisor had to discuss it with me. They even go as far as saying - they are aware that they have never seen me looking messed up but it's somehow become an "issue." Or I got paged countless times during my vacation - I was out for a week - clearly I'm not going to answer my pager when I'm not on clinical duties. I got labelled as a non- pager responder - which is a "problem" - even though I have not made it an issue until recently that nursing staff and therapists don't answer their phones/pagers on a regular basis.

The issue is - perhaps I'm not likeable in this setting, which is odd because in previous settings I have been called "pleasant, sweet, gentle" etc. So people try to make big issues out of nothing. I even told my advisor recently - I feel ridiculous having to run to the chief about every single little thing out of fear that there will be some negative outcome out of things that should not be. The response was that I should still do so so that they could "take care of things."

Why is it that I can let things slide right and left but everything I do is a mortal sin?

Why is it that out of the 10 nursing evals that I have from my most recent rotation, 8 of them are 3-4/4 and 2 are not good. Clearly I can't be that hateable and terrible if most of the staff is fine with my work, attendings were extremely happy with my work, patients were well taken care of.

So there is some issue - that no one is willing to address - that cannot really be resolved. I'm more than happy to have an honest conversation with people to try to resolve things - but it doesn't seem like most things in certain environments want a resolution. Many other residents have had the same experience in the rotation. So when there are repetitive problems it typically is a 2 body problem. If only one body is "dealt with" the problem is bound to recur.

A few thoughts come to mind as I read this post:
1) You should absolutely get on lower level residents who are not doing their jobs properly. "Not finishing work on time, not doing admissions correctly, not following up on plans, putting in wrong orders, forgetting to write notes" (quoted from your post) are problems that cannot be left uncorrected. You are doing them a disservice by just fixing their mistakes for them. More importantly, these are all basic skills and duties of being a doctor which they are not learning and will one day harm patients. You need to address these problems when they happen, make the interns fix their own mistakes, and keep addressing it until they stop making these mistakes.

2) Being disrespected by lower level residents is a problem. Thought #1 above may contribute to this. Alternatively, if it is just 1-2 interns, it is more likely a personality problem with those individuals that needs to be addressed.

 

[Pixiwoman]

What to do when nursing staff put orders under your name that were not authorized? This is clearly a medico legal issue. Who do I report it to?

Yes, you need to talk with the attending in charge immediately , and never sign anything you didn't order or did not agree with just because a nurse wrote it or told you to sign it, that can be way risky for your career as If something bad happens you are the one to blame

 

[evilbooyaa]

Omg lol I couldn't imagine an intern yelling at a upper level resident for anything besides an immediate, patient-threatening issue.

OP - you need to have balls to govern the people that you have power over. You do not have power over the nurses, but you do have power (not necessarily an obligation to abuse it) over the interns, who seem to not be getting **** done correctly.

To answer your OP - likely in error if it was a one time occurence. One of my friends discovered during intern year that nurses were verballing orders which weren't correctly coming to him to sign, but were being auto-signed (they retroactively saw it was an EMR issue as he was on vacation with orders being signed while nurses were putting in orders). Nurses got a long talking to about the inappropriateness of that (even though it was minor stuff, not sedatives, etc.) However, I don't think that's the case here.

To confirm other perspectives - You need to get on your lower level residents for not doing their **** right. Otherwise they'll have no idea that it was wrong in the first place.

 

[Pixiwoman]

Omg lol I couldn't imagine an intern yelling at a upper level resident for anything besides an immediate, patient-threatening issue.

OP - you need to have balls to govern the people that you have power over. You do not have power over the nurses, but you do have power (not necessarily an obligation to abuse it) over the interns, who seem to not be getting **** done correctly.

To answer your OP - likely in error if it was a one time occurence. One of my friends discovered during intern year that nurses were verballing orders which weren't correctly coming to him to sign, but were being auto-signed (they retroactively saw it was an EMR issue as he was on vacation with orders being signed while nurses were putting in orders). Nurses got a long talking to about the inappropriateness of that (even though it was minor stuff, not sedatives, etc.) However, I don't think that's the case here.

To confirm other perspectives - You need to get on your lower level residents for not doing their **** right. Otherwise they'll have no idea that it was wrong in the first place.

Communication is the key lol

 

[Pixiwoman]

thats different. a verbal order is fine - this was not even discussed with me

That is unacceptable and should be reported !

 

[Winged Scapula]

Yeah doing the intern and junior level resident duties is an issue.

In fact, when I was a second-year I got a talking to because I would clean up after the interns and make sure everything got done so the service would run smoothly. The trouble is that the interns then don't learn that they're doing something wrong.

Furthermore if you have a more of a passive personality, they soon assume that you will do their work for them and treat you as an equal or subordinate and walk all over you


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[Pixiwoman]

Yeah doing the intern and junior level resident duties is an issue.

In fact, when I was a second-year I got a talking to because I would clean up after the interns and make sure everything got done so the service would run smoothly. The trouble is that the interns then don't learn that they're doing something wrong.

Furthermore if you have a more of a passive personality, they soon assume that you will do their work for them and treat you as an equal or subordinate and walk all over you


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I agree with you, they took advantange of me in residency too as I was trying to be nice

 

[Winged Scapula]

I agree with you, they took advance of my in residency too as I was trying to be nice

I don't know if I ever got taken advantage of because I'm not that nice LOL


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[Pixiwoman]

I don't know if I ever got taken advantage of because I'm not that nice LOL


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I guess I don't know how to be mean... unless by husband makes me angry and then I do know lol

 

[SouthernSurgeon]

Yeah doing the intern and junior level resident duties is an issue.

In fact, when I was a second-year I got a talking to because I would clean up after the interns and make sure everything got done so the service would run smoothly. The trouble is that the interns then don't learn that they're doing something wrong.

Furthermore if you have a more of a passive personality, they soon assume that you will do their work for them and treat you as an equal or subordinate and walk all over you


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This is something I've had to work with our mid-level residents. They find it very easy to be the "best intern" and just do the interns jobs for them and correct mistakes. Their default is to drop back into that intern role. Getting them to delegate and hold their juniors to standards is a challenge

 

[Lostin_space]

This is something I've had to work with our mid-level residents. They find it very easy to be the "best intern" and just do the interns jobs for them and correct mistakes. Their default is to drop back into that intern role. Getting them to delegate and hold their juniors to standards is a challenge

That's the thing though. If I try to be nice, flexible, send people home early - because I had many nice residents when I was a student - I'm viewed as too lax, not involved enough, not wanting to teach, etc. If I'm very strict (ie- I had to tell one of my jr residents to do a number of things a number of times for example) I'm viewed as a witch. So its a really hard balance to have. Most of my upper level residents that I have had though have not provided a ton of teaching, support, etc. in general. They were nice people overall but not so much of a support role I guess. So for me I just tend to do whatever moves the team along.
After I've told the same resident to fix things 10 times - what do I do? I guess if I'm firm - that's unprofessional and it lands me in really hot water. If I don't fix it, the attending gets upset or patient care suffers and I'm not allowing that. It's really a hard situation to be in.

 

[Lostin_space]

Yeah doing the intern and junior level resident duties is an issue.

In fact, when I was a second-year I got a talking to because I would clean up after the interns and make sure everything got done so the service would run smoothly. The trouble is that the interns then don't learn that they're doing something wrong.

Furthermore if you have a more of a passive personality, they soon assume that you will do their work for them and treat you as an equal or subordinate and walk all over you


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Yeah to some extent - but again perhaps because I tend to be more introverted and what not I don't like to be bossy or mean - but I find that it's hard to find a balance as it seems I'm screwed either way. Too nice - not involved. Too strict - witch.

 

[ProfMD]

That's the thing though. If I try to be nice, flexible, send people home early - because I had many nice residents when I was a student - I'm viewed as too lax, not involved enough, not wanting to teach, etc. If I'm very strict (ie- I had to tell one of my jr residents to do a number of things a number of times for example) I'm viewed as a witch. So its a really hard balance to have. Most of my upper level residents that I have had though have not provided a ton of teaching, support, etc. in general. They were nice people overall but not so much of a support role I guess. So for me I just tend to do whatever moves the team along.
After I've told the same resident to fix things 10 times - what do I do? I guess if I'm firm - that's unprofessional and it lands me in really hot water. If I don't fix it, the attending gets upset or patient care suffers and I'm not allowing that. It's really a hard situation to be in.

Yeah to some extent - but again perhaps because I tend to be more introverted and what not I don't like to be bossy or mean - but I find that it's hard to find a balance as it seems I'm screwed either way. Too nice - not involved. Too strict - witch.

No one said it was easy. Most people aren't naturals. Its a learned skill like everything else. However, you need to try and get the interns in line.

 

[Lostin_space]

No one said it was easy. Most people aren't naturals. Its a learned skill like everything else. However, you need to try and get the interns in line.

Not just interns but also second years. What if they trash me on evaluations?

 

[ProfMD]

Not just interns but also second years. What if they trash me on evaluations?

Not knowing you or your program, I can't really give specifics. All I can say is you need to find a balance. Think about how your seniors treated you.

As long as you treat them fairly, things will work out.

 

[Lostin_space]

Not knowing you or your program, I can't really give specifics. All I can say is you need to find a balance. Think about how your seniors treated you.

As long as you treat them fairly, things will work out.

My seniors did not do most of what my jr residents dinged me for not doing. I got pretty much bare bones and was told not to be difficult and not question it. One of my jr residents criticized my vacation time, complained about pt load, having to do meetings. Etc

 

[ProfMD]

My seniors did not do most of what my jr residents dinged me for not doing. I got pretty much bare bones and was told not to be difficult and not question it. One of my jr residents criticized my vacation time, complained about pt load, having to do meetings. Etc

Sounds like your juniors are running roughshod over you. This is likely due to one, or more likely a combination, of two factors:
1) You juniors are a$$hats.
2) You let it happen.

Not much you can do about #1 but you can definitely address #2. You aren't there to be their friend. You are there to teach them and take care of patients.

 

[FutureInternist]

Yeah doing the intern and junior level resident duties is an issue.

In fact, when I was a second-year I got a talking to because I would clean up after the interns and make sure everything got done so the service would run smoothly. The trouble is that the interns then don't learn that they're doing something wrong.

Furthermore if you have a more of a passive personality, they soon assume that you will do their work for them and treat you as an equal or subordinate and walk all over you


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One of my attendings was talking "sternly" to an intern on our team about not following Hgbs that she (intern) had ordered. I tried to step in & said that as the senior I should have followed up on it & it wasn't intern's fault.
She's like "OK FI, since you want to help the intern out why don't you take all her pager calls for the next time she is on call" ...and I did :-(
She (attending) later explained her reasoning & cautioned me on coddling interns before they get in a position to really do some damage

 

[Siggy]

Omg lol I couldn't imagine an intern yelling at a upper level resident for anything besides an immediate, patient-threatening issue.

I did... once... and that's because it's pant's on head stupid to do a huge workup for an AKI when you have a baseline creatinine from 5 days ago and a recent history of nausea/vomiting/diarrhea and no indications for renal replacement therapy. There's zero reason to consult nephro in that patient until you try to actually be a doctor and treat the patient. However that senior never met a consult she didn't like. Being a specialist in internal medicine should mean something besides being able to put in consult orders.

 

[Pixiwoman]

I guess I don't know how to be mean... unless by husband makes me angry and then I do know lol

But I do love my husband a lot

 

[Lostin_space]

That's the thing though - that's what I think too that as a senior I feel that my role is indeed to teach them, guide them through and take care of patients first and foremost, not be their friend. But in particular one of the jr residents did not follow directions frequently so I made a lot of corrections, talked to this person repeatedly about the same thing, etc. This resident also seemd to have either envy or lack of understanding about hierarchy. When evaluating me, this resident questioned jsut about every decision, including my time off, me not being "available" enough even though I was there 9 hours a day, the resident expected assistance with every family meeting, expected me to round/see his patients in the PM aside from rounds, etc. What kind of jr resident a-makes comments like that b-thinks he has the same "rights" if you will as an upper level resident? I have yet to fill out this person's evaluation, but it shocks me that they would think filling out an eval like this would be acceptable.

And in regards to sternness and what not, how do you deal with this? I have not only been yelled at but have been disrespected by senior residents before. I have yet to do that to anyone, yet somehow I had a comment on an eval that I answered the phone with attitude and i had to meet with an advisor for "professionalism" issues. I just don't get it. We have no power to actually do our jobs and yet jr residents can be insubordinate, but somehow that's ok. I don't know how to deal with things like this.

Sounds like your juniors are running roughshod over you. This is likely due to one, or more likely a combination, of two factors:
1) You juniors are a$$hats.
2) You let it happen.

Not much you can do about #1 but you can definitely address #2. You aren't there to be their friend. You are there to teach them and take care of patients.

Sounds like your juniors are running roughshod over you. This is likely due to one, or more likely a combination, of two factors:
1) You juniors are a$$hats.
2) You let it happen.

Not much you can do about #1 but you can definitely address #2. You aren't there to be their friend. You are there to teach them and take care of patients.

 

[FutureInternist]

My philosophy on consults in an academic institution

Inpatient - Work it up as much as you can using brains, colleagues & of course UpToDate, then call consultant, stating exactly what you have done & what you think the next step might be & why & ask what they think

Outpatient - Refer as soon as you can, since you would hate to start someone on heart failure meds then get a Cardio appt 3 months later only to find out they should have been on a different regimen. I used to send them with a "What do you think of these meds" question. This way you catch any mistakes earlier

 

[Pixiwoman]

My philosophy on consults in an academic institution

Inpatient - Work it up as much as you can using brains, colleagues & of course UpToDate, then call consultant, stating exactly what you have done & what you think the next step might be & why & ask what they think

Outpatient - Refer as soon as you can, since you would hate to start someone on heart failure meds then get a Cardio appt 3 months later only to find out they should have been on a different regimen. I used to send them with a "What do you think of these meds" question. This way you catch any mistakes earlier

This is a good tool, useful

 

[Pixiwoman]

Sounds like your juniors are running roughshod over you. This is likely due to one, or more likely a combination, of two factors:
1) You juniors are a$$hats.
2) You let it happen.

Not much you can do about #1 but you can definitely address #2. You aren't there to be their friend. You are there to teach them and take care of patients.

This is hard sometimes, as you might see some interns as friends and then the commanding becomes weird...

 

[Fiveoboy11]

Tread carefully. If one nurse did this, consider talking to them first, to see if it was just an error. Or do as suggested and speak with your attending. That will give you a better sense of the culture and protocols at your institution and maybe spare you some trouble.

While there are some practices which are not entirely medicolegally ideal, but are never-the-less the standard practice at a given facility. If this is one nurse who overstepped, and if the order was for something potentially dangerous for the patient, that is one thing. But if it is common practice at this place to avoid paging in order to get those innumerable, trivial orders for things like PT/OT consults or other routine things like that... Look, I'm not saying it is right, but that is just how a lot of places run.

Especially when the physicians and nurses know each other well, often the latter put the orders in and tell the docs later what they did. Yes, that is outside the nursing scope of practice. But it is still the way a lot of places operate. I'm not saying that you shouldn't challenge that, even if it is the way things are usually done there. If you feel it is unsafe and don't want your name on it... well, there is a right way to go about it.

Trivial "PT/OT" consult? The only things that are trivial and routine about it is your understanding. How many observation hours do you have with a licensed PT? Zero? Do you really comprehend that physical therapy and occupational therapy are separate professions and so the "PT/OT" nonsense is nothing more than a reflection of your incompetence and ignorance? What classes in rehabilitation have you taken?

 

[ProfMD]

Trivial "PT/OT" consult? The only things that are trivial and routine about it is your understanding. How many observation hours do you have with a licensed PT? Zero? Do you really comprehend that physical therapy and occupational therapy are separate professions and so the "PT/OT" nonsense is nothing more than a reflection of your incompetence and ignorance? What classes in rehabilitation have you taken?

No need to be defensive. No one is saying PT or OT is trivial, just the order/consult request. It is a low risk, but often high value, request.

 

[Psai]

Trivial "PT/OT" consult? The only things that are trivial and routine about it is your understanding. How many observation hours do you have with a licensed PT? Zero? Do you really comprehend that physical therapy and occupational therapy are separate professions and so the "PT/OT" nonsense is nothing more than a reflection of your incompetence and ignorance? What classes in rehabilitation have you taken?

The order is trivial. We did not design the EMR or the PT/OT order. We really don't care about what you do, our goal is simply to get the patient better so that they can get out of the hospital. Please get over yourself.

 

[evilbooyaa]

Trivial "PT/OT" consult? The only things that are trivial and routine about it is your understanding. How many observation hours do you have with a licensed PT? Zero? Do you really comprehend that physical therapy and occupational therapy are separate professions and so the "PT/OT" nonsense is nothing more than a reflection of your incompetence and ignorance? What classes in rehabilitation have you taken?

Lmao. That's a random thing to get butt-hurt about.

PT/OT is not trivial. The consult order is, because people always forget it, and almost every patient besides those walking around of their own volition without significant prodding (read: almost none) would benefit from having PT/OT work with them, at least for initial evaluation.

If the patient can do all OT tasks, then I expect OT to eval and sign-off. If patient can walk just fine, I expect PT to either ask me (rare) or eval and sign-off.

While it's not 100% correct, I always think about it like this - PT is big movements (walking, getting out of bed, etc.), OT is more for fine motor stuff (dressing oneself, brushing teeth, etc.). You need both for 90% of the debilitated patients that end up becoming inpatients.

 

[Fiveoboy11]

The order is trivial. We did not design the EMR or the PT/OT order. We really don't care about what you do, our goal is simply to get the patient better so that they can get out of the hospital. Please get over yourself.

You and your cohort don't have a clue what you're doing or what you're talking about with regard to rehabilitation so I'd suggest you guys just do your own job, get over yourselves and never have any say whatsoever with regard to rehab ever again.

 

[Fiveoboy11]

Lmao. That's a random thing to get butt-hurt about.

PT/OT is not trivial. The consult order is, because people always forget it, and almost every patient besides those walking around of their own volition without significant prodding (read: almost none) would benefit from having PT/OT work with them, at least for initial evaluation.

If the patient can do all OT tasks, then I expect OT to eval and sign-off. If patient can walk just fine, I expect PT to either ask me (rare) or eval and sign-off.

While it's not 100% correct, I always think about it like this - PT is big movements (walking, getting out of bed, etc.), OT is more for fine motor stuff (dressing oneself, brushing teeth, etc.). You need both for 90% of the debilitated patients that end up becoming inpatients.

It's clear you know little to less than nothing about what you just babbled about. Very superficial and uninsightful.

 

[Fiveoboy11]

No need to be defensive. No one is saying PT or OT is trivial, just the order/consult request. It is a low risk, but often high value, request.

May want to tell some of your stuck in the past colleagues who testify to the government re our "danger" to the patient.

 

[rokshana]

You and your cohort don't have a clue what you're doing or what you're talking about with regard to rehabilitation so I'd suggest you guys just do your own job, get over yourselves and never have any say whatsoever with regard to rehab ever again.

dude, you need to get over yourself....one why are you even in this forum? but two the "trivial" part is that practically every person >70 is m/l will benefit from the PT and the OT consult...night float usually misses it because they are thinking about the NOW things to do...not something that will take place the next weekDAY, and it many times it doesn't get addressed until the day before the pt is leaving...

i have no problem if the nurse puts in the order under my name...i'll probably think "thanks!" and co sign the order...i can't think of a time this order would create a problem for me...hence the "trivial" aspect of the order...

though i'm not sure why PT in many places don't think there is a need for them to see the pt on say, the weekends...

 

[Psai]

You and your cohort don't have a clue what you're doing or what you're talking about with regard to rehabilitation so I'd suggest you guys just do your own job, get over yourselves and never have any say whatsoever with regard to rehab ever again.

Say this to me in person. I'll take care of that attitude real fast.

 

[Raryn]

You and your cohort don't have a clue what you're doing or what you're talking about with regard to rehabilitation so I'd suggest you guys just do your own job, get over yourselves and never have any say whatsoever with regard to rehab ever again.

Look, it's a trivial order because it's one that cannot hurt the patient.

If the nurse puts an order in my name for a medication? Potential to harm the patient. Even things such as tylenol could potentially be contraindicated for whatever reason. Heck, the only completely benign pharmacological treatments I could think of would be things like osmotic laxatives, and even they have contraindications.

Nurse puts an order for oxygen under my name? Happens all the time. Or they do it without an order. Still has the potential to harm the patient, whether through worsening a V/Q mismatch (causing potential for more CO2 retention), the haldane effect, reducing the respiratory drive, or anything else.

On the other hand, if the nurse uses my name to order a PT, OT, nutrition, social work, or other ancillary service consult? It may be too early to do any good, but it doesn't have the potential to actively harm the patient. *Most* patients have some component of deconditioning. All patients have the question of their ultimate disposition. When it's not obvious, we consult our colleagues in physical and occupational therapy to assist us with evaluation and management of the patient.

I have the utmost respect for both disciplines... but the act of placing the consult order itself is trivial.