Taking admission orders over the phone.

how can you do that if the patient is in the ER, before they've gotten to the floor? Don't you have to have admitting orders to get to the floor? I've never heard of a floor nurse taking orders on a patient not yet there....

I've taken orders on "direct admits" plenty of times.

cheers,

ED nurses take orders routinely on patients whom they know NOTHING about. But wherever I've worked, the bed people had to have a name, age, dx and type of bed required before issuing any assignment of which floor or bed.

We recently instituted CPOE (computerized physician order entry, for those unfamiliar--all docs put in their own orders) and I had my first verbal admit orders yesterday. I learned a couple of lessons. #1--It is best to refuse to take verbal orders if possible. (Not the few ED ones--I am talking the whole list of admission orders) It took me no less than 1-2 hours with direct hands-on assistance from computer personnel for me to enter the physician's orders correctly. #2--If I have to take the orders, I will sit at the computer, pull up the screen, and read every line to the physician for verification. (One episode of that should bring verbal orders to a screeching halt; my charge nurse was not happy that I was required to take the orders.) The doc who handed me the phone apologized repeatedly; I think when the ED docs see what happens, they will deflect the verbal order requests. One can only pray.

I tried to do written ones on our old format like it used to be, and send it with the patient to the floor, but that requires the nurse on the floor to sit and go through what I was trying to avoid in the ED. So I got bit this time, but next time it will be "aren't you able to enter these? You know I am required to put them directly into the computer, and if I don't I will have to call you repeatedly over the next 2 hours to clarify every pharmacy override, missing order, etc, etc...." "Yes, I really think you should either come in, do these at your office or get the hospitalist to admit for you..."

Sorry this was so long--had to vent. And no, the secretaries are not allowed to do any computer order entry, and no one but the doctors can enter the diagnosis and condition of the patient. That slows order entry even more, because those entries generate the proper order sets that I have to search for separately.

Oh, well. I have two days to recover!

direct admits through the ER?

Well tonight I took verbal orders over the phone and this not supposed to happen now with our new system, EPIC. AND, the Doc was quite rude. Our hospital gave all the docs I guess these 'palm pilots" so they can enter orders from wherever they are. But I knew this was going to happen, Docs can do anything they want. They don't have to play by the rules like the rest of us. When I heard we were going to this new system I knew they would not be compliant.So, this Doc went on "the list" of offenders. Hopefully our Ceo of nursing will do something about it.

verbal orders over the phone are "telephone orders."

Oh, yeah thats right duh, orders over the telephone ARE telephone orders. Wow guess my 3.98 GPA wasn't workin' there, huh. See this is typical in the nursing profession, I write in to share the frustration of something and some smart ass has to try to correct you. This is why people are getting out of the profession because of the dog eat dog mentality. Hey thanks for the correction, I really needed it.