102

Policies and Procedures

11. Writing of Patient Care Orders


1. Routinely, the Internal Medicine residents write all orders for the patients for whom they are
caring.

2. Nephrology fellows write all orders for procedures and treatments that require subspecialty
expertise and that are beyond the scope of internal medicine training. These include: acute
and chronic hemodialysis, peritoneal dialysis, continuous renal replacement therapy,
plasmapheresis and the monitoring of a patient undergoing renal biopsy.

3. Attending physicians may only enter orders on teaching patients in the unusual circumstance
when the fellow is unavailable and patient care could be compromised by any delay.
Attending physicians are expected to discuss these orders with the fellow and residents
caring for the patient.

4. Attending physicians and fellows should also adhere to the GME Policy Concerning the
Writing of Patient Care Orders Outlined below on page 104 of the fellows manual.
























103


Graduate Medical Education Policy Concerning the
Writing of Patient Care Orders
http://www.ecu.edu/cs-dhs/gme/customcf/policies/WritingOrders.pdf

1. Residents who possess an unrestricted license or training license issued by the Board of
Medical Examiners of the State of North Carolina may write patient care orders for patients
receiving care in facilities operated by Vidant Medical Center and East Carolina
University.

2. They may also write patient care orders in facilities which have affiliated with Vidant
Medical Center for residency training through an Inter-institutional Agreement, Letter of
Agreement, or similar formal training agreement.

3. Residents must be directly involved in the decision making process related to "do not
resuscitate" and cytotoxic chemotherapeutic agents orders for patients in whose care they are
directly participating. Residents, identified above, may write "do not resuscitate" and
cytotoxic chemotherapeutic orders for these patients, but a responsible attending physician,
prior to implementation, must countersign cytotoxic chemotherapeutic orders.
Countersignature may be obtained as a verbal order. "Do not resuscitate" orders must be
signed by the attending physician within twenty-four (24) hours in order to remain in effect.

4. When a resident physician is directly and significantly participating in the care of any patient,
the attending physician should refrain from writing patient care orders for that patient. When
circumstances dictate that the attending physician must write patient care orders in teaching
patients, this should be communicated promptly to the resident participating in the patient's
care.


This policy supercedes all previous policies related to this issue.


GMEPC Approved 3/2000