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is it legal to write an order for a resident at a facility when they are discharged from it and admitted to a hospital or another facility?

Wednesday January 22, 2014
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Question:

Dear Nancy,

I work as a staff RN at a county nursing home. I was written up for a medication error. A resident returned to the facility from being admitted to the hospital. The return date to facility was April 9. There was a script written on April 8. I assumed the order was previously written and did not apply to her current orders, which were all dated April 9. My question is, is it legal to write an order for a resident at a facility when they are discharged from it and admitted to a hospital or another facility? I did not know how long she had been out of the nursing home.


Darcy



Dear Nancy replies:

Dear Darcy,

The situation you describe is one most often faced by many of your nurse colleagues. The issue here is not that the orders were written prior to discharge. Indeed, the hospital needs to identify medications the patient was taking and/or needs to continue taking once the patient returns to a facility, is admitted to a new facility, or is to be cared for in a home care situation. The confusion appears to arise because one medication had a different date for its order in contrast to the other medications' order date.

A simple solution to such a situation is to have a policy at your facility concerning residents that are admitted or readmitted to your facility with medication orders. It is hoped that those orders would be reviewed and either reordered by the attending physician/medical officer or other healthcare provider at your facility that is authorized to prescribe medications (e.g., an advanced practice nurse) after the patient is assessed upon admission or readmission.

Having a specific policy for you or someone in your position would take any guesswork out of which medication is to be continued and which is not at your facility. It also would provide guidelines for you to follow so that a clear obligation about medication orders exists, and would result in being written-up if not fulfilled. As it stands, one staff nurse's guess as to what to do is as good or bad as another staff nurse's.

Regards
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.