Telephone Orders- Perplexed in MA!

[kathybMA]

My first post :smilecoffeecup:

I work in the acute care setting, in the Float Pool, and this is my kerfluffle with posting telephone orders.

A nurse working on the unit with me came over to me and said "can you post these for me"; it was a fairly long set of telephone orders that SHE had taken- she wanted me to post and sign off on them.

I asked around, and a lot of the other nurses do the same thing- they take telephone orders and have another nurse post and sign off on them. The nurse signing off the orders does not hear the phone call from either end.

The nurse who takes the orders does NOT sign off or post them, just their sig after the MD's name and the T.O.

Now, am I being too AR or what, to my way of thinking (as well as how I was taught) why would I want to sign off and post something that I never heard??? To me, that says I witnessed it.

My mind's in a muddle. LOL

I hope everyone is having a great weekend. I am working :smilecoffeeIlovecof

Kathy

[CaLLaCoDe, BSN, RN]

Sounds like risky business; and I wouldn't agree to putting the orders in the computer and noting them, no way!

My other gripe is having a physician write "check peak and troph on vanco" and the results come back high 20.6 ^

So you call the doctor and the doctor says, "You know you don't have to call me, just put the vanco on hold till and wait for future orders."

NOW, isn't that an order! It's my license not hers!

And she is rude and hangs up on me! Now I feel like calling her at three a.m. tomorrow for an ingrown toenail to be swabbed for fungal infection?!:angryfire :angryfire :angryfire

[morte, LPN, LVN]

hmmm last time i took a t.o., i actually asked if it were acceptable to note and post my own order.....the point (i thought) of having another nurse note and post was to double check....you are not signing that you took/wrote the order, only that you are noting/posting it.....you note and post docs written orders,yes? wht is the difference?

[rnin02]

Maybe I'm sleeping deprived, but I'm a little confused by what you mean by "post the orders". I would certainly never take a telephone/verbal order from a doctor, then turn to someone else and say "Dr. X told me to do x,y and z. Can you write this out for me?" If I get a TO/VO, I write it on the chart myself, and I would never write out someone else's orders for them. The only exceptions I can think of are during emergencies when one nurse is on the phone with the doc and I might write down med orders as she reads them back to the doc so we can get the order to pharmacy that much faster. And that's just a maybe exception.

Now, if I'm the next shift coming on, and the nurse before me had a TO/VO written on the chart I treat it like a regular order: if she hasn't been able to do all the order yet, for example if she hasn't had a chance to transcribe the meds to the MAR, I will do that and sign off the orders as noted.

[Chaya, ASN, RN]

Nope. Would NOT do it. (I might, however, ask if there was something else I could do for her so she had time to do it herself)

[jill48, ASN, RN]

I have had to deal with this quite often when it gets very busy, and I have been on both ends of the situation. What I usually do is write T.O., then the order, then per so and so, then a slash, then MY SIGNATURE. Then, of course, the date and time. And it may not even be me or the other nurse who actually takes off the order, so another nurse may even come behind us and sign it again when SHE takes off the order.

[clee1]

I am still in orientation, and my preceptor's name goes on each and every assessment I make or med I give, as she usually right behind me. However, when I take a TO, my name goes on it in the chart and I have to enter it in the computer under my ID.

It is a legal responsibility I'd never try to put on someone else, and one I'd never let someone put on me.

[chenoaspirit, ASN, RN]

I wouldn't write them for another nurse unless there was some emergent reason she couldn't do it, and then in that case I would either not sign the orders (let her sign her name when able) OR (if it was a nurse I knew well and trusted), I would print her name and sign my name behind it.

Ditto to that. Who is to say that the nurse heard the order correctly. Then you sign it and YOU are responsibile for any outcome. Either I hear it myself and write it/sign it, or I will sign my name then per "nurses name". Preferably Id write it and allow the nurse to sign it later when she can. I worked too hard for my license to risk it for anyone.

[km5v6r, EdD, RN]

:uhoh21: I am confused also. Once the orders are written on the chart what does it matter as to who wrote or notes them? Once they are written any other nurse may note or sign them off. Most of the time I will note orders on my patients but if I'm extremely busy someone else may note them. As the person noting the orders I want to know that the orders have been placed in the computer correctly, and transcribed to the MAR correctly. To my knowledge noting the orders means someone is aware of the order and it has been implemented. If I note an order for a CXR I know the order was placed in the computer. If it was an order for a med; then a copy of the order went to pharmacy and the med was written on the MAR usually with administration times assigned. When I worked in acute dialysis it was common for the charge to get the orders for the day from the physician and hand them off to the nurse doing the treatment to implement and note. Sometimes the orders would be called into one facility for a pt at a different facility. OTOH outside of an emergency I do not take orders through a third party. I have heard the nurse on the phone taking orders from a doc and implemented them before they were written ie stat CXR, stat EKG, stat lab ect. But the nurse who took the order is the one to actually write it on the chart.

[lsyorke, RN]

I'm not sure I'm understanding here. If a nurse takes a telephone order, writes in in the chart and reads it back to confirm the order with the doc, that's the way to do it. Now what happens after that is up to your facility. In most hospitals that I've worked in the unit secretary takes puts those orders in the computer and flags the chart for signing off by the nurse.

I've never heard of the nurse taking a telephone order having to do all the order entry associated with that order. If I had to order entry every telephone order I took, I wouldn't get anything done!! We do take off ALL our medication orders.

[rnin02]

I'm not sure I'm understanding here. If a nurse takes a telephone order, writes in in the chart and reads it back to confirm the order with the doc, that's the way to do it. Now what happens after that is up to your facility. In most hospitals that I've worked in the unit secretary takes puts those orders in the computer and flags the chart for signing off by the nurse.

I've never heard of the nurse taking a telephone order having to do all the order entry associated with that order. If I had to order entry every telephone order I took, I wouldn't get anything done!! We do take off ALL our medication orders.

I put my own orders it, if I'm not too busy and I know the secretary is busy. I have to go behind her and check it before I can sign it off, so sometimes its just easier to do it in the first place. But, we don't have to put it in our own orders, unless there isn't a secretary.

[nuangel1, BSN, RN]

in the ed i work we take admitting orders from the md via phone all the time.as per our hosptal policy we read every order back to the md then write at bottom t.o.my name /md name date and time.then pt gets to floor in hospital and the floor secretaries take the orders off.

[ckben]

i personally feel that there is absolutely no excuse for taking a phone order and not writing it yourself. you cannot ask anybody else to do that for you. is there anybody who wasn't taught that in school? i don't think i'd want to be a patient on the floor where this kind of practice is allowed...