Instead of the doctors signature on the orders, you can do a telephone order on them. They don't actually have to be signed to use them. The only way the preprinted orders can even be considered an order is if doctor either called and said "use the preprinted orders", or he verbally said such, or if in the case of an ER admit that says for example "Use Chest Pain Protocol Orders", in the place for the doctors signature, you put in a telephone order, verbal order, or recopied order with dr name and your own. ....like this......say the ER orders say "Use Chest Pain Protocol"

You would then get the pre printed orders and use the ER doc's name to sign those at the bottom where the signature would go..........EXAMPLE:

Recopied Order Dr. Jones/D. Bishop, R.N.

Did that help? Your manager is right...case in point....patients admitted at night time when no doctors are there, you can't just not initate orders because they aren't signed yet. That would be with holding treatment and prolonging the patients stay, other wise it would be that theoretically you could only treat the patient when a doctor is readily available to sign orders which is unrealistic. Also, just an FYI, doctors have a minimum of 24 hours to sign orders initiated without a signature and some cases much longer.
Hope that helped.

Denise

" Thanks for your reply, but you are contradicting yourself. You mentioned",The only way the preprinted orders can even be considered an order is if doctor either called and said "use the preprinted orders", or he verbally said such". But then you are saying my manager is right. Well the problem is the orders are pre-printed and without any kind of verbal order in action, we are still to give the vaccine. What if the doctor decides to cross that particular order out the next day after you have already given the med??? I can understand what you are saying about with holding treatment, however, giving a medication that can wait until the next day(without an order ) by all means is not "with holding treatment".I really appreciate your time and if you can maybe expclin better, I'd be very grateful.
Thanks

Hi! I apologize for that. Maybe I am a little confused by what exactly you are asking then. What kind of pre printed orders are you referring to then? I don't understand how this order set gets into the patients chart then as a part of an order if there isn't any physician saying "use this order set" or something like that. I mentioned the "Chest pain orders" to explain what typically happens at my hospital. I get patients from the ER that basically just have "Admit to telemetry, diet, iv, activity, meds, etc, but then it says "Initiate Chest Pain Protocol". For that, we get the pre-printed order set and make that a verbal or recopied order to get those initiated.
I guess i am unclear on just how you even know to put that particular order set on that patient. If you could explain that a bit more, maybe i can offer more advice. Sorry for the confusion.

Denise

P.S. I just thought of one more possibility. We have a vaccination screening tool that is included with every admission. This is to screen for Pneumonia and Flu vaccines. There are questions for the patient to determine if either or both of thes vaccines are indicated for each patient. For example, asks if have had the vaccines recently, asks if currently flu season, asks allergies to eggs for flu vaccine, and also has a spot if pateint does not want the vaccine. After you have asked the questions, you see if the vaccines are indicated or not indicated based on their responses. If they are indicated, that paper is scanned to the pharmacy and the vaccines are sent up to give. This screening tool and ordering and giving tha vaccine does not require a physicians signature at all, not even as a telephone or verbal order. The hospital as a whole is able to offer and give those vaccines as a community illness prevention tool. There is actually a policy stating that this can and is done without physican consent and all doctors are aware of this. Patients are also told that this is not required but is a choice left up to them.

Is this more of what you are referring to? You can email me privately as well if you wish. I will return the email but it may be a day or so as I don't check my email everyday. I hope this helps. :-)

[email protected]

Pre-printed orders
Do the pre-printed orders have areas for specific orders to be checked off. If the orders have these check blocks...which some do then the doc has to check the ones he wants used...if not then the pt gets a hep b vaccination ...if the pt wants it.

It sounds like a newborn nursery, where Hep B is routinely given with parental consent. And that's the key issue. Do you have the patient's/parents' consent? If so, give the vaccine. I don't of any doctors who would fail to sign this order to begin with.

In some hospitals (teaching, with a lot of residents), I consider pre-printed orders as if they were hospital policy. But you can always protect yourself by getting a telephone order to cover yourself. Just exercise judgement and don't call the physician in the middle of the night for these things.