Wrinkly Ranch Documentation

Advanced Orders & Documentation: Driven by Convenience or Best Practice?

A quick note to discuss something I was confronted with recently. While I do not profess to be an expert and it is by no means my intention to be recognized as one – or to pontificate on what ought or ought not to be correct – I do think the following is an example of an aspect of responsibility/care that is worthy of discussion.

How can you know?

Wrinkly Ranch IV PoleI understand and agree with a standard of nursing practice whereby there are limited clinical circumstances for which pre-written orders are appropriate (i.e., if XX happens, you may do YY). But pre-written documentation? Can the responsible clinician pre-write a Medical Certificate of Death for a (palliative) resident (i.e., before a weekend or statutory holiday) for someone else to fill in the date and time after the death? What if they were not deemed palliative beforehand?

Such practice results in the RN on duty subsequently submitting a Ministry document online that confirms there was nothing untoward or suspicious about the death (thereby negating the need for an autopsy). While we must acknowledge that it is unlikely that there is/are any underlying change(s) in the contributing factor(s) of the deteriorating clinical presentation or palliative process, without the most responsible clinician writing the documentation only after physically being present to assess and confirm the cause of death, how can one be certain?

Slippery slope?

Wrinkly Ranch Stethoscope

As an extension, should it then also be permissible to pre-write the subsequent orders to release the body to the funeral home? To destroy their medication?

Should it be employed even if acknowledging such practice is strictly permissible and recognized? I mean, I concede it might be convenient for some but still…



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