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Refusing Dr's orders
The problem in a nutshell: Nursing home resident with weeping edema of lower extremity with large erosion. Doctor ordered "Apply Duoderm daily." As it was a holiday weekend, did not call doctor but faxed for clarification on order. Plastering a Duoderm on her eroded skin was against my better judgement. Wound was cleansed with saline and applied nonadherent dressing until I got an answer. Family member called and went ballistic. "Put the Duoderm on her now!" I did. Question: When are we within our rights to refuse to carry out an order? What to do when waiting for an answer, carry out the order anyway? Is there a standard protocol for this?
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Document, document! You were right in trying to get order clarified, and if it means calling the DON and Medical Director of the facility, do so. The facility can get tagged for this, I am sure.
Anyhow, Duoderm? I would opt for Tielle (or something along that line), if there is skin erosion.
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Why did you not call the MD and request that the wound be assessed? What stage was the erosion? Did you notify supervisor?
What problem came out of this? I need more information of this situation.