Verbal orders vs Telephone orders

[DEB52]

There has been a recent change at our hospital on how we handle verbal orders. If the Physican is on the unit giving you verbal orders ,you are to hand them an order sheet and ask them to write them. If the doctor calls you on the phone , you take the order then read it back verifying the order.When you chart it you write "TO" to signify that it is a telephone order. It's been hard convincing the nurses and the doctors that this is the way it has to be done. The doctors have been informed in their meeting. How doe's your hospital handle verbal orders vs telephone orders?

[JaredCNA, CNA]

Our nurses still write out verbal orders. They have to put V.O. (nurse's name and credentials)/ (doctor giving order)/ VORB (nurse's name and credentials.) Example: VO John Doe, RN/ Dr Smith/ VORB John Doe RN.

The addition of VORB is just to indicate the verbal order is read back to the physician. It is the same with telephone orders, except it is TO instead of VO.

[VikaRN_2008]

I am a newer nurse just licensed last August. I'm not sure I understand what is meant by losing your license over a med that wasn't prescribed. Is this to say that if the physician gives me a telephone order for a medication and doesn't sign the order until the next day or so, then it is technically not legal? Or is this on a different track altogether?

I'm a new nurse (just licensed this month) and wondering about that too.

[Bumashes, MSN, APRN, NP]

Ours has us write either VORB or TORB (Verbal Order Read Back or Telephone Order Read Back). Then we put the doctor's name slash our name, like this : TORB Dr. Martin / Jane Doe, RN. We take the order verbally or on the telephone, write it down, and then we read it back to them for added clarity and safety.

[Med Surge 2]

Heh, there are quite a few times that I would like the doc to let me write his orders. At least I can read my handwritting.

I feel like telling the doc, here this is a typewritter start typing or here is a tape recorder.

Anybody know how to get the docs handwritting to be legible?:bowingpur

[Tina1639]

I work in a Cardiac ICU and we're given more autonomy to make certain decisions which enables us to write VO's and call and get PO's. I'm not sure if y'all are talking about settings other than ICU's? As I've been taught we write the order just like Susan wrote above but we write RBV/our initials below the order to indicate Read back & verified. This is actually the first I've heard of the JCAHO requirements for VO/PO's.

I actually asked a DR the other day about D/C'ing a drip my patient was on and she said that was ok but forgot to write the actual order and I had to go back to the chart and write a VO to D/C the med.....which is very common for us.

Are ICU's going to be losing that autonomy according to the new JCAHO requirment?

[enmack]

are nurses allowed to give orders to another nurse that they received from a dr

[pumlittlekin]

These are new TJC (the new & improved JCAHO) requirements: we got audited this spring and after the visit we were told the same thing; the only time we can take a verbal is if there's a code running.

that is true, i was threatened by a doctor since i told him i cant take a vo unless it is an emergency. he said he was going to report me and have me fired. I explained that there are new regulations and he should write the order down, i gave him the chart, some order sheets and he sat down with the chart. When he is done he wrote nothing. luckily some page the SOB, so when that nurse was done i spoke to him to get the TO but he refused to give me the order. and said he was going to report me the next day. I gave him my name and said ok. I'm expecting to hear about this soon form my DON. I hate some doctors.

[adventure780, BSN, MSN, RN, APN]

I am a new nurse. I just started working and I am wondering about this issue too. In education they told me write the order then T0 Doctor's name and then co sign my name next to it then write read back and confirmed, which is accurate according to JACHO? My preceptor said to write TO. doctor's name/ my name then the order followed by my signture

[ayla2004, ASN, RN]

no verbal orders in my hospistal in in the Uk. we do use electronic presribing so either we ask a doctor on the ward, or bleep on call medic and wait for it to pop up.

For non electronic medication like iv fluids etc we need a iv prescription chart and a medic has to come the ward and prescribe sign, orwe can bring the sheet to the doctor and then hang the fluids

[ZippyGBR, BSN, RN]

If you do not take TO's how do you contact doc when he is not in the facility to address something?

in the UK there is always a middle grade presence on site in an acute hospital ... even the smallest site in our trust which as only about 60 overnight beds has a middle grade available via it;s (not really an ) Emergency department .

Surely the pt does not have to wait until the doc gets there for something that is needed now?!

see above there is a physical presence by an on call doctor either a junior and/or middle grade 24/7/365 ( juniors are the first 4 years post reg reg and middle grades are higher trainees ( StR 3-7) or career middle grades ...

we can order our own pathology tests as RNs and depending on setting - imaging, if there is an existing standing order / Patient group directive we can initiate that that , ditto if there are PRN medications prescribed or it falls within the hypoglycamia or anaphylaxis bundle ...

[ZippyGBR, BSN, RN]

that is true, i was threatened by a doctor since i told him i cant take a vo unless it is an emergency. he said he was going to report me and have me fired. I explained that there are new regulations and he should write the order down, i gave him the chart, some order sheets and he sat down with the chart. When he is done he wrote nothing. luckily some page the SOB, so when that nurse was done i spoke to him to get the TO but he refused to give me the order. and said he was going to report me the next day. I gave him my name and said ok. I'm expecting to hear about this soon form my DON. I hate some doctors.

attack is the best form of defence - incident form it before the doc gets his spin on it

[dutchgirl123]

This could be a new topic... has anyone thought about why we don't have hotlines, or special phones to call doctors, and special lines to receive calls from doctors, to report findings or to get orders from? It seems all businesses now use recorded lines "to provide improved customer service". It would seem to me that something so CRUCIAL as med orders, or any orders from a physician to a nurse, or a pharmacist, or a therapist, should be electronically recorded! For the protection and safety of the patient, the doctor and ME, the person who is NOT a doctor, but who has to take the orders, or "clarify the orders" (because physicians insist on writing "resume previous" even though the patients level of care is changed, and a MEDICAL assessment is required....)

I could rant and rave about this all day, but it has to start somewhere!

Why aren't we nurses insisting on doing this, when credit card companies are, cement companies are, insurance companies are.....

Perhaps it time to get this dialogue going, esp for those nurses in this string who have said that someone "denied" giving an order to them....