Conclusion
Hospitalists write conditional orders every day. In fact, all "PRN" orders are conditional and presume the use of nursing clinical judgment. However, some conditional orders are directed at other physicians or services (for example, "Discharge the patient if OK with surgery" or "Resume Coumadin if OK with orthopedics").
Often these orders are expedient and typically replace direct communication. But hospitalists should remember that such conditional orders trigger a potential act of commission with nursing as the communication "go-between." There was nothing unreasonable about the conditional order for Lovenox in this case per se. Yet, had this order not been written at all – the chain reaction that subsequently occurred may have been avoided altogether. The jury in this case returned a defense verdict in favor of the hospitalist.
Dr. Michota is director of academic affairs in the hospital medicine department at the Cleveland Clinic and medical editor of Hospitalist News. He has been involved in peer review both within and outside the legal system. Read past columns at ehospitalistnews.com/Lessons.