It is time to eliminate hospital policy-generated computer physician orders. Hospitals must not be allowed to create a policy with a computer-generated order without the physician acknowledging the order with the physician’s name attached to it. Let’s bring back physician-run medicine again. The physician has control over all orders with their name attached to them. Plus, the physician needs to start informing the patient about the medication they are ordering and the alternatives. i.e. atorvastatin v. krill oil, both lower cholesterol and have harsher side effects.
Where is this happening and can you expand on this? I’m a NP and all orders in the patient chart must be originated and signed by a provider, at least in my 30 year experience in New York, Chicago and Kentucky.
Many hospital generated policies that center on physician orders are evidence based and reduce mortality and morbidity. Such as central line care bundles, or early septic shock recognition and treatment bundles. I myself created one for management of acute heart failure. But all these require a provider order and signature.
Please explain further.
I currently live in PA and I use EPIC EMR. The hospital I work at was acquired by Kieser Medical from California. So last year I was dc a pt and the flu shot popped up on my MAR. I found this quite odd because the pt has an allergy to the flu shot ingredients. Because I was taught to question everything the physician does, so I naturally texted him for clarification. So I texted him. [you know the patient is allergic to the flu shot ingredients, right? I saw you ordered her the flu shot with your DCI. He responded I know she is allergic to the flu shot and I did not order the flu shot for her. I probed, so you did not order the flu shot for her? He said why would I order the flu when I know she has an allergy. I said the flu shot was ordered for her under your name. I asked don’t you find that quite concerning the computer is ordering your patients the flu shot without your knowledge of it.] It was at this moment I realized the computer must have an augarhythem to order the flu shot if not documented they received it for the flu season when the DC order is generated. I have found numerous mistakes with the flu shot on ppl over the last year. But if I was not a seasoned nurse who questions everything these MDs do. I would have harmed the patient. How many nurses just follow orders and blindly just do things?
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I use Epic too. There are these types of algorithm prompted orders. They usually come up in a highlighted box to suggest to the provider to order it. The issue is it pops up for EVERY provider. There are usually 3 or 4 possible responses - 1. Order whatever it is suggesting. 2. Some type of not applicable or do not order (in which the provider has to specify why they are bypassing this) 3. Select “not primary team (or essentially not my problem).
The issue is there are so many pop up windows that we (providers) have “pop up window fatigue” and often click on it without realizing.
My suspicion is that this is the scenario you are encountering with these types of mistakes.
That’s why nursing is SO important and I might add undervalued. Nurses are the last check to the patient.
I would encourage you to “write this up” when it happens and include the pharmacy on the incident. The pharmacy should also be catching drug allergies.
Great catch and thank you for being an awesome nurse! Go nursing!!!
It’s kind of like how often times NP and PA orders go under the physicians name at pharmacies and other places often times.