Good afternoon,

I recently had an issue where a patient was refusing doses of his anticoagulant. Per policy the nurses were indicating the doses were omitted on the MAR, but the physicians doesn't routinely view the MAR so he wasn't aware.

Does anyone have a policy that address a situation like this and provide guidance to nurses on when to contact the physician and make them aware?

Should such a policy address the number of refused/omitted doses?
Should such a policy take into account the type of medication involved?

Thank you ~Jennifer