Telephone orders...read back and verified...

  1. We were just told today in our staff meeting that we are suppose to read back telephone orders to the doctors and then sign it "read back and verified." I always read my orders back to the physicians when I take telephone/verbal orders but just sign T.O. Dr. Smith/B.Boop, RN. Boss said this is something that our lovely friends at JCAHO want and the state inspectors. News flash: I can write that to the cows come home, but if it comes down to brass tacks it is still my word vs. the MD's word about the orders. Gee, who thinks up this crap? If you really want it verified then there should be a third party on the line to witness everything. Otherwise it boils down to doc said/nurse said baloney.

    Fortunately most of the physicians I work with are pretty decent about telephone orders. Since we are a small facility and such we get to know each other well. I guess other nurses aren't so fortunate and probably have ran into doctors denying they ever gave a telephone order even when they did. We only had one doctor that I didn't trust in that manner and I would always get a second nurse to verify his orders. (He retired several years ago, thank god. I really think the man was going senile).

    Anyway, just more charting for us nurses....
    Last edit by deespoohbear on Feb 28, '03
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  2. 37 Comments

  3. by   RN-PA
    You've GOT to be kidding. If I have to write "read back and verified" with every verbal order, I will have a rubber stamp made with that written on it and I will use it. JCAHO needs to get real and get a life.
  4. by   Maerzie
    DeesPoohBear--

    I have experienced a problem like this with a doctor who used to deny what he told the nurse about O.B. patients in the middle of the night. The way we resolved it was to always have another nurse on a second phone also listening to the order and we BOTH had to sign off the order.

    You're absolutely right tho regarding the fact that a doctor's word will be taken over yours---YOU are easier to replace!! or so they think!! And JCHO requirements are getting too ridiculous too! It is alway so obvious that these surveyors haven't practiced (hands on nursing)in the REAL world OR have been out of real practice for a good twenty years, IF indeed they EVER did REAL nursing! Some went right up the school ladder and right into jobs making rules.
  5. by   Chiaramonte
    Have been told the same thing at work this week.
    They have circumvented it by making us initial
    "RBAVTO". "Read Back and Verified Telephone Orders".
    We have one physician in particular ,when awakened in
    the middle of the night for orders ,states we should just
    transcribe the 4 pages of meds from the nursing home...
    well... we have an ongoing battle when I insist on reading
    them back to him. Now at least I have back up from the powers that be that this HAS to be done.
    By the way, we are getting rid of the JCAHO ritual this year...or so they say...will wait to see if they actually do.
  6. by   Mimi2RN
    Our docs now have to sign, date and time telephone orders within 24 hours. Another doc from the same group can do this, so it doesn't cause problems.
    We have clerical staff coming around checking charts at least twice a day, they make copies of orders and fax them to the appropriate docs. Supposedly, this is because of JCAHO. Also the docs can be fined several hundred dollars for being noncompliant.

    Has anyone else heard of this?
  7. by   NRSKarenRN
    Just had JCAHO survey 2 weeks ago. That is part of their national safety agenda BECAUSE too many orders are being written incorrectly and docs denying that order read back to them.

    Improve the accuracy of patient identification.
    use at least two patient identifiers (neither to be the patient's room number) whenever taking blood samples or administering medications or blood products.
    Prior to the start of any surgical or invasive procedure, conduct a final verification process, such as a "time out," to confirm the correct patient, procedure and site, using active--not passive--communication techniques.


    Improve the effectiveness of communication among caregivers.
    Implement a process for taking verbal or telephone orders that require a verification "read-back" of the complete order by the person receiving the order.
    Standardize the abbreviations, acronyms and symbols used throughout the organization, including a list of abbreviations, acronyms and symbols not to use.


    Improve the safety of using high-alert medications.
    Remove concentrated electrolytes (including, but not limited to, potassium chloride, potassium phosphate, sodium chloride >0.9%) from patient care units.
    Standardize and limit the number of drug concentrations available in the organization.


    Eliminate wrong-site, wrong-patient, wrong-procedure surgery.
    Create and use a preoperative verification process, such as a checklist, to confirm that appropriate documents (e.g., medical records, imaging studies) are available.
    Implement a process to mark the surgical site and involve the patient in the marking process.


    Improve the safety of using infusion pumps.
    Ensure free-flow protection on all general-use and PCA (patient controlled analgesia) intravenous infusion pumps used in the organization.


    Improve the effectiveness of clinical alarm systems.
    Implement regular preventive maintenance and testing of alarm systems.
    Assure that alarms are activated with appropriate settings and are sufficiently audible with respect to distances and competing noise within the unit

    http://www.jcaho.org/accredited+orga...sg/npsg_03.htm
  8. by   MishlB
    We were always taught to document the verification of verbal orders. It's really not that much more writing, if that's what the complaint is. Remember...if it wasn't documented, it wasn't done.
  9. by   deespoohbear
    Originally posted by MishlB
    We were always taught to document the verification of verbal orders. It's really not that much more writing, if that's what the complaint is. Remember...if it wasn't documented, it wasn't done.
    Yeah, but it is just me talking to the doc and no one listening in on the orders, it basically would boil down to my word against his. You can write "read back and verified" till the cows come home but that won't prove a darn thing if the doc denies it. All he/she would have to say is "they never read the orders back to me, the nurse is lying." Wouldn't have a leg to stand on unless you had a second person on the line with you. Fortunately, I don't see a problem at our facility with the docs doing that but I know some of the other posters here probably aren't as lucky. I only have to deal with about 10 docs total so you get to learn which ones to trust and which ones to watch your back.

    I do read back the orders to the doctor, but like in my original post I just sign T.O. Dr. Smith/B.Boop, RN. Next thing the idiots at JCAHO will want will be the second person on the line to listen to the orders or better yet drag some physician out of bed at 3am to come into the facility and write the orders. In a small facility like ours, we take an incredible amount of telephone orders. We do not have a house doc 24/7 except for the ER doc and they are only suppose to give orders for floor patients in a critical/code blue situation. Otherwise it is to the family docs we go.

    I just see this as another way to add more work to the nurses already heavy load! If it wasn't for all the paperwork in triplicate I would be able to spend actual time with my patients instead of their charts.

    I thought I read somewhere that JCAHO was going to try to streamline some of the documentation so nurses and others weren't writing the same thing in a pt's chart in 10 different spots. Guess that got tossed, huh? I really believe the people at JCAHO think nurses and other healthcare workers are dumber than a box of rocks and wouldn't have enough sense to come in out of the rain. Kind of got off topic here, but geesh JCAHO annoys the daylights out of me!!
  10. by   deespoohbear
    Originally posted by NightMoonRN
    By the way, we are getting rid of the JCAHO ritual this year...or so they say...will wait to see if they actually do.
    Oh, if you do can I come work for your facility? Has the higher ups stated why they are contemplating not doing JCAHO survey this year? I bet it boils down to the money we pay JCAHO to come in and tell us we are idiots!! Keep us updated!!
  11. by   Chiaramonte
    Yes,it indeed is simply a matter of money here,deespoohbear.
    We just suffered a big blow to our ancillary staffing.
    They cut 30 non- licensed positions. Now get this reasoning...
    they gave all of us licensed people a 5 percent raise and then within the next week pulled the rugs out from under all these EDTs and aides!
    First of all, I would gladly forego the raise to keep our hard
    working ancillary staff on board. We are a small community and ALL of these people are our friends.
    Second of all, they gave us a raise with the suspected anticipation that they are going to raise our insurance out-of pocket pay in. Also, I am anticipating a forced .8 status to cut the amount of money they have to reserve in the vacation pool because of course even though your benefit package doesn't change persay, your actual accrual is smaller with .8 .
    I feel so let down by this administration. Last year the ER and hospital was operating in the black and now we are in such a financial crisis! Someone should have been minding the books closer, I think.
    I agree with your frustration with JCAHO though. It seems they are so far out of the loop of reality. If they think more paper work generates better patient care, they are fooling themselves. Just look at the way things go back to "the way they've been done for years" after the inspectors are gone!
    Thanks for letting me vent here about our crisis. It's just so frustrating! So, I guess if you would like to venture to work here because of non-JACHO status, you had better check to see if the RNs are still working here at all. This skeleton crew of just RNs left behind are searching for employment elsewhere! Not that hard to find right now. Can't wait to see our top heavy administration emptying bedpans and giving enemas!! Ya right!!
  12. by   emily_mom
    Originally posted by NightMoonRN
    Have been told the same thing at work this week.
    They have circumvented it by making us initial
    "RBAVTO". "Read Back and Verified Telephone Orders".
    We have one physician in particular ,when awakened in
    the middle of the night for orders ,states we should just
    transcribe the 4 pages of meds from the nursing home...
    well... we have an ongoing battle when I insist on reading
    them back to him. Now at least I have back up from the powers that be that this HAS to be done.
    By the way, we are getting rid of the JCAHO ritual this year...or so they say...will wait to see if they actually do.
    RBAVTO here too....
  13. by   Repat
    We write TO Dr Death/RV Nancy Nurse, RN
  14. by   KaroSnowQueen
    Yep, us too, started this fall.
    TO: Dr. Frog/KNurse,RN/RV
    Like that RV means squat. We can write it but does it mean the doc will admit if it 's wrong??? I seriously doubt it.
    So many of our docs have thick accents, Spanish, Middle Eastern, Filipino. Some of them are very hard to understand, and if you ask a couple of them especially to repeat, they get ticked off, curse and hang up. Then you have to call back and really tick them off. Makes for a fun night.

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