Refusing Doctor's Orders

4 posts · started May 30, 2012

Maddie May 30, 2012, 5:26 AM

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?

cougarnurse May 30, 2012, 6:22 PM

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.

hppygr8ful Jul 18, 2012, 6:38 PM

I think I would have requested a wound care consult - Then document the condition of the wound border and skin and why the Duoderm might be inapproriate - like documenting irritation to skin. Also document when you called the doctor. Holiday weekend not-with-standing there should have been a doctor on-call to handle these situations.

Photo's of the wound are also very appropriate in such a case

Hppy

cougarnurse Jul 19, 2012, 1:12 AM

The camera we used for wound documentation was always locked up in the DON's office. Kinda hard to get to on holiday weekends when she'd be 300+ miles away, across state.... But you are right, hppy.