Without Orders

Hey all! Have been reviewing multiple websites, state government and blogs and found that laws are very vague. I know this is to allow grey areas to occur to allow patient safety as well as protect nurses and other health professionals in emergencies but I was wondering...what are some of the things that you all can do without doctors orders? Obviously comfort is a consideration here but name some examples all responses welcome
On my floor, we don't need order to start IV but do need if the access is other than IV.

Quote from Apollo8933what are some of the things that you all can do without doctors orders?

Really? That's pretty incredible and surprising actually! So you don't need an order for just NS? For hydration?

I think she means just placing a peripheral IV - not running fluids

Quote from Born_2BRNOn my floor, we don't need order to start IV but do need if the access is other than IV.

I have what we call progressive orders. Otherwise, its business as usual.

We have some older nurses who are comfortable with our docs, so if the patient's BP tanks out they will start a fluid bolus immediately and then call the MD to tell him later once the patient is ok. The MD is always like, "yeah, yeah, that's fine". I guess technically the order is covered then but I'm not brave enough to do that

Each hospital varies due to their policies and procedures. Since I'm in the ICU, we often are required to take action without a doctor being there right away. We receive all the necessary orders after the fact, and then some. The nice thing is your can receive the orders in person or over the phone, and enter them yourself .

Quote from emtb2rnYou may want to doublecheck your facility's policy. I'm pretty sure a iic/heplock requires a physician order. It's invasive. Could be wrong, wouldn't be the 1st time.

I need to clarify what I wrote. I meant if their old IV (not fluid, we talk PIV insertion) had gone bad or they come up for blood transfusion not through ER. Yes, I know you suppose to get order everything. I remember I got ding for given patient a bandaid after he bumped himself. He asked for it and as a new nurse I didn't know better. Can you imagine being punished for given patient a bandaid?

If a facility has standing orders for giving Tylenol or starting an IV in certain situations, you're still technically following doctor's orders. Such policies were still written bu medical staff, and I'm betting there's some sort of document somewhere detailing these orders that bears a physician's signature.I'm pretty sure there's just about nothing in the way of medication administration that nurses initiate completely independently of some sort of physician's order. At least not in a hospital or LTC facility.

There's usually an order to insert a PIV, and then the system will automatically reorder it every 96 (on EMR). As long as the the admission orders have an order for an IV, any reinsertion is covered per protocol.There are many things that you don't need a doctor's order for. These days, hospitals have moved toward evidence-based medicine and many of the bundles are already pre-approved by hospital administration and medical directors. You are allowed to insert an NG on intubated pts, you are allowed to program feeding pumps to flush with 30 ml water every 4 hrs unless the volume is specified different, you can use clog-zapper on clog feeding tubes, etc.Many orders also fall under nursing or ancillary order sets and they don't need a doctors order. You can initiate fall precautions and a dietician can order PO vitamin C and zinc for wound healing without a doctors order. If you are ACLS certified, you can initiate CPR, you can defib, and you can pass ACLS drugs like (epi, atropine, vasopressin, etc) without a doctors order. That's because it's already pre-approved and the time of response in a code is vital. Almost everything these days has a protocol. If a pt was obviously septic, I'm not gonna wait for a call back before I start the nursing portion of the sepsis bundle. Most things that don't need an order is already technically ordered by the medical directors.