Writing orders

[owen_osh]

I was looking at First Aid for the Wards and a couple other books about 3rd year. They all said that you should write all orders for your patients and have them checked and signed by the intern or resident or whatever.

Well, today I was talking to some 4th years, and they said that this isn't really possible at our hospitals because they use electronic medical records. (I guess the order must be typed on a work station and immediately entered into the system. You probably don't have time to wait around looking for someone to sign off on it.)

Have any of you had this same experience? Do you still get to write orders? Any advice or insight would be appreciated.

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[Smurfette]

I was looking at First Aid for the Wards and a couple other books about 3rd year. They all said that you should write all orders for your patients and have them checked and signed by the intern or resident or whatever.

Well, today I was talking to some 4th years, and they said that this isn't really possible at our hospitals because they use electronic medical records. (I guess the order must be typed on a work station and immediately entered into the system. You probably don't have time to wait around looking for someone to sign off on it.)

Have any of you had this same experience? Do you still get to write orders? Any advice or insight would be appreciated.

Remember that FA tells general advice. Each hospital service runs slightly differently. As a med student, your order-writing will often consist of someone telling you exactly what orders to write for OR someone pretty meticulously checking the admission orders they ask you to get started. It is technically illegal for an order made by a med student to be carried out without a MD co-signature (I say "technically" b/c it happens often that the co-signature does not come until after-the-fact---but if something went wrong, the person who carried out the order would be responsible, as the order was not official if not co-signed---then again, it is very frustrating to write for something simple or obvious for a patient and have it not able to be carried out until you find your intern to cosign it). Generally speaking, you don't pre-round on your patients and write orders you think up for them in the morning before discussing the patient with the team. P.S.---as hard as you try, it is rare to write ALL orders for your own patients...if the attending or chief change their mind about something with your patient, the order may be written before you even hear about it...this is why you need to constantly check the patients' orders to stay on top of things.

As far as computer order systems, most that I have seen/used allow med students to enter orders, but then residents or attendings have to confirm them under their login...some residents find it easier just to do the orders themselves since they "pop up" for their approval anyhow.

hope this helps answer your question.

 

[Febrifuge]

I work in an ED where we have electronic everything. When a student is coming in for a rotation (usually 4 weeks), they get a userid for the system which includes privileges for writing orders. Also part of that user profile is the need for all that person's orders to be co-signed by staff or supervising resident. So, it's just like the process you describe... only all Jetsons-style.