My institution was visited by JCAHO the week of September 11, 2001 (yes, they went through with the survey despite the terrorist attacks!). We scored well, but spent months worrying, fretting, and preparing beforehand. To keep up to date for future visits, I read a newsletter called "Inside the Joint Commission." One of the topics in the December issue was concerned with how to get MDs to sign their verbal orders. This was also a huge focus of our preparation for the recent JCAHO visit.
The article - and our administration - suggests that nurses should be the ones to ensure that physicians sign, date and time their orders. Doesn't this perpetuate the idea of nurses in a "handmaiden" type role to the doctors, while excusing inappropriate behavior on the part of the MD's? We must remind, beg, plead, and cajole someone into doing their job? If I forget to sign a nursing assessment
, is it reviewed by another person and flagged for my attention? No. The newsletter article makes suggestions for getting doctors to sign their orders, including the usual flagging of incomplete orders, but another suggestion is that institutions host lunches at which the charts are available to be signed while doctors eat a free meal. Doesn't this reinforce or reward negative behavior? My institution initially suggested that the secretaries or the nurses fill in the date and time if they witnessed the MD writing the order. We refused, believing that to be falsification of records since we didn't write the order, and also because it doesn't deal with the problem - the physicians!
I'm sure others have dealt with this problem. What are your thoughts?