Physician Orders - Delaying Execution Policy

Physician Orders – Delaying Execution Policy

Effective Date: [Original NPP Date]
Revised Date: [Current Date]

Goal

To assure that physician’s orders are correct and complete before initiating them.

Policy

A physician’s order must always be correct and complete before execution. It is the nurse’s responsibility to ensure the accuracy and completeness of the order.

Procedure

If a nurse questions whether an order is correct or complete, the nurse may delay executing the order following the procedure outlined below:

Written Orders – Physician in the Facility

1. Review with Physician: Discuss the order with the physician until it is confirmed to be correct and complete. Refer to the Physician’s Desk Reference (PDR), policy manuals, or other resources if unfamiliar with the medication or treatment.
2. Execution: If satisfied with the order’s correctness and completeness, execute the order.

Written and Telephone Orders – Physician Not in the Facility

1. Consultation: Discuss the order with the Supervisor and refer to the PDR, policy manuals, or other resources.
2. Verification Call: If the nurse still questions the order, call the physician to repeat and read back the order, explaining any concerns.
3. Execution: If satisfied with the order’s correctness and completeness, execute the order.

Further Clarification

1. Escalation: If not satisfied after speaking with the physician, discuss the order with the Supervisor and Director of Nurses (DON) or Assistant Director of Nurses (ADON). If a medication is involved, call the pharmacist for further clarification.
2. Final Review: If the order is still in question, the Supervisor will call the Medical Director to discuss concerns. If the Medical Director confirms that the order is correct and complete, execute the order.

Documentation

• Intent to Delay: Document the intent to delay the execution of the physician’s order in the nurse’s notes.
• Clarification Steps: Document all steps taken to clarify the order, including discussions with the physician, Supervisor, DON, ADON, pharmacist, and Medical Director.

References

• Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
• CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]