Download ARTICLE IV. PHYSICIAN`S ORDERS AND STOP ORDERS A

ARTICLE IV.
PHYSICIAN'S ORDERS AND STOP ORDERS
A.
PHYSICIAN'S ORDERS
1.
Physician Personal Order Sets
a.
Individual practitioners who formerly had pre-printed orders or
physicians requesting the creation of personal order sets (POS) will
submit the orders to the Admitting Orders Department to be forwarded to
the Computer Order Entry RN for creation of, and/or changes in POS.
A current copy of the computer generated print-out of POS will be
reviewed, signed, and dated by the practitioner to maintain a current
master file.
b.
Personal order sets must be reviewed annually by the responsible
practitioner.
c.
Residents may use the attending physician's personal order sets by
accessing the computer system.
d.
All other patient care orders shall be in writing and each order or group
of orders shall be signed by a practitioner.
2.
Verbal/Telephone Orders
a.
Only an appropriately licensed individual (i.e., a resident or licensed
registered nurse) may accept telephone orders or verbal orders from a
practitioner. Such orders shall be signed by the appropriate person with
the name of the practitioner or resident and the name of the person who
took the order.
1)
One exception: a secretary in the Emergency Department or in
a scheduling center may accept orders for diagnostic
examinations, consultations or referrals. They cannot take
orders for medications or treatments.
b.
At, or before the time of final record completion, the attending
practitioner will be responsible for countersigning the appropriate verbal
orders.
c.
Verbal or telephone order may be countersigned by the ordering
practitioner or his designee.
3.
Residents' Orders
a.
Residents may write patient care orders under the supervision of an
attending practitioner or senior resident. Such orders are to be routinely
reviewed by the attending practitioner or senior resident and may be
amended as deemed appropriate indicating revision by countersignature.
4.
B.
Do Not Resuscitate Orders
a.
Do not resuscitate (no signal) orders may be given as a telephone order
and must be countersigned within twenty-four (24) hours. Failure to sign
the order will result in its cancellation. No signal orders are usually
suspended when patients go to surgery unless otherwise indicated by
written order by the physician. The attending physician and/or surgeon
will discuss the matter with the patient or patient’s representative. Postoperatively the order for No Signal must be rewritten to reinstate the
order.
AUTOMATIC STOP ORDERS
1.
Drug Orders
The Hospital "Automatic Stop Order Policy for Medications" is designed to insure
the proper administration of selected drug categories under reasonable Medical
Staff control and to prevent the continuation of administration of dangerous drugs
in lieu of specific practitioner authorization. The dispensing and administration of
the selected categories of medications will be automatically discontinued after the
indicated time period has elapsed following the original or renewal order of the
practitioner unless:
a.
the order indicated an exact number of doses to be administered;
b.
an exact period of time for medication administration is specified;
c.
the order is renewed by a practitioner;
d.
implementation of the stop order may be delayed up to an additional
twenty-four (24) hours, when the nurse is unable to contact the
practitioner, but is aware of the practitioner's preference to continue
medication. Efforts to contact the practitioner will continue.
Medication Category
Automatic Stop
Narcotics
3 Days
Hypnotics
7 Days
Anticoagulants
(Coumadin)
24 Hours
Antibiotics
7 Days
2.
Respiratory Therapy
A six (6) day automatic stop order will be applied to inhalation therapy treatment
order by practitioners or residents. Oxygen equipment "stand-by" orders are
discontinued after three (3) days of nonuse.