JCAHO: "Behaviors That Undermine A Culture of Safety"

re problems with doctors giving orders over the phone:


Whenever I call my insurance company or bank, etc. a voice message alerts me beforehand that the call will be recorded. Couldn't that be applied in the hospital system also? If not, what would be the objection?

An agency nurse told me she worked at a hospital where calls were recorded... the problem is that when you work with a licensed professional they need to be held morally, ethically and legally accountable for their behavior and judgment, not only because they know there is a recorded trail of evidence to defeat bogus claims. If I am at the bedside of a coding fresh post-op heart on a cellular there's not an easy way to have it recorded... if the physician is next to me and gives a verbal then what? Am I supposed to say "speak into my badge please..." or "Hold on... let me flip the tape?"... I don't mean to be sarcastic... your idea is a valid one... but it will only apply to mainline calls that are recordable and will not address the underlying issue...If I write verbal orders from rounds that the PAs or NPs forget... then same issue... As far as witnesses... this surgeon denied the order that was made during rounds with case management, the unit's nurse manager, 2 PAs and the critical care nurse present... now that's brazen! Now that I am making a stand on this I have the benefit of management having heard the same thing I did... so there are many witnesses and the surgeon is going to have to answer to it because I am not going to let it slide...there is an upper management meeting about this being held...but that won't protect me from retaliation...I am quite frankly terrified of a surgeon that demonstrates the proclivity to act above accountability...

Furthermore, if a tape is required then it undermines nursing authority in charting... my charting should be evidence of the events of the day, including a verbal order noted on the chart itself and in my nursing narrative... I shouldn't have to have a tape to back up my documentation... if a tape is required against a nurse's word...then our documentation is subsequently deemed unreliable...and that changes the current standard of care... Quite frankly, if I need a tape to back me up... I don't feel safe working on the unit... that's my big issue...

So... yes, you are correct in suggesting a way to have indisputable evidence... but my point is this...as a licensed clinician, I shouldn't need to go that far... if I do... then I won't take verbal orders...period!

NTE, I never thought about cell phones and forgot about verbal orders, so obviously my suggestion is mute. As you can see by my user name, I'm a patient not a medical worker. I can now appreciate your dilemma. Thanks for the explanation.

When I read the article last night, I jumped for joy, and printed it out and sent it to several other units. The hospital I work for takes JCAHO very seriously. This is about the only way things are ever going to change.
The nurses on my rehab unit have been bullied by both our nurse manager and the highly acclaimed orthopedic surgeon who runs it. We have had charts and coffee cups thrown at us. We have been called names, denied breaks and meals, and when several of us went together to upper management, with dates and details, we were told that "she's retiring in 2 years, you don't understand how stressful her job is, I'll talk to her and see."
The surgeon demanded I write a verbal order on a chart that he had sitting in front of him, so I had to put my saggy 50 year old breasts practically in his face to pick up the chart, in front of witnesses. I felt so humiliated. My manager would of course not back me up. Last week I told her as she passed on his latest tirade, that since she allows him to bully her , he thinks that it's OK to bully the other staff. He is a great doctor, I can call him at 3 AM if his patient needs something and get a thank you for calling. But I was really thinking of leaving until this came out.
This gives me hope, and a solid logical reason to go back to management next time with documentation and say, This is what's happening.This is a honest to God Sentinel event, with fines for non compliant hospitals. Whatcha gonna do?
Thank you for letting me vent, it's out of my system now and my heart is filled with peace. God bless all you brave heroic nurses for the courage you display by just showing up for work every day.

No problem AP, thanks for your input and participation on this thread!

Thank you for the link. My hospital is instituting just such a policy; we are in the beginning stages of formalizing it. I emailed myself to my work email so I can distribute the article.

When I saw the title of this thread, I thought it was addressing the behaviours of patients and families that undermine our safety...for patients and staff., and that JCAHO was going to do something about it. Like take it seriously.

I'm sure it will be enforced. Forms will be created that the nurses have to fill out hourly checking off that all communications are civil and sweet. If the forms aren't filled out, nurses will be written up.

An assistant manager I used to work with had a great idea for doctors who denied that they had given a verbal order. She got in their face with a camera, snapped their picture (with flash) and posted it on a bullition board at the front desk where everyone who passed by could see it. With the picture was an enormous sign: "Do not take verbal orders from this weasel who will just as likely deny every having given it."

Worked like a charm.

Though I agree with the idea in principle, the cynic in me can't help but wonder how anyone thinks this can be enforced.

No one deserves to be bullied, harassed, or otherwise mistreated at work. However, one persons perception of "bullied" isn't necessarily the same as another's.

Most blatantly bad behaviors are already prohibited by institutions' codes of conduct.

I see a bit of promise with respect to addressing the behavior of non-employees (eg physicians, vendors, contract employees). However, I'm skeptical that JC can come up with guidelines that will yield an effective, efficient way of managing this on the part of institutions.

As MLOS stated above, most facilities will probably come up with some form that the nursing staff will have to fill out q shift. So now, in addition to charting on our patients, we'll have to chart on our coworkers and physicians, as well. Because as we all know, there is no problem in health care that can't be solved with an additional piece of paper that has to be filled out, photocopied, and forwarded to the NM and risk management.