The Art of Writing Orders
I continue to be obsessed with residency, and psychiatry. I truly love the fact that I actually get paid to learn. The interesting thing about residency is that you learn many different things, obviously including patient care. But I enjoy that you also learn about the real “meat and potatoes” of being a doctor.
One lesson that I keep learning is that there is an art to writing orders. Knowing which medication, lab, procedure, etc. to order is only one piece of the puzzle. Learning how to write GOOD orders is a whole ‘nother ball of wax. Some lessons/things to keep in mind that I’ve learned so far:
1. When writing strange/titration orders, it’s always best to clarify to the nurse EXACTLY what you mean. I learned this lesson the hard way, and a patient stopped receiving their antipsychotic medication because I/the secretary/the nurse/the pharmacist failed to clarify the order.
2. If you write for a STAT (emergency) medication, it’s always best to also inform the nurse verbally, and to also be prepared to defend why you are giving the medication.
3. There are people who have to complete the orders. There are no magical fairies who draw labs. If a patient is a difficult stick, or frequently refuses bloodwork, you should aim to get the best bang for your buck. Order all bloodwork at the same time, when possible.
4. Change of shift! Nurses are not on the same schedule as the doctors (usually). They really do not like it when you write orders near their change of shift. Good to keep in mind.
5. New/strange medications frequently have to get sent up to the unit by the pharmacy. The earlier you order them, the sooner the pharmacy can send them up, and the more likely your patient will receive them the same day.
I have some other tips in mind, but just realized that this might make a good Medscape post, so I will leave it at that for now.
Time to walk the doggies. And eat!