Checking peer orders and counter signing

[PsychNurseWannaBe, BSN, RN]

Hello,

I recently was told that when new orders are received they need to be checked by another nurse. So as an RN, if I receive a new order, I need to go to my counterpart and have her initial the order as well. Apparently her initials state that I transcribed the order correctly but not that the order in itself is correct. I stated to my manager that if another RN wants me to initial that she/he transcribed the order correctly, there is no way for me to know that the order is truly correct or even safe because I didn't take the order (phone, verbal). But I find it hard to believe that I some how wouldn't be held responsible or accountable in some way if an adverse effect happened to a patient. I don't know my counter parts patients, so if she would get an order that maybe should be questioned and she didn't question it and I not knowing the patient said, yep you transcribed it right...couldn't the BON state, well there are 2 RN signatures on this order and something bad happen and come after my license even though I didn't take the order?

I am sorry if this is confusing. I have been up a while. :wink2:

[Whispera, MSN, RN]

All your initialing does is say that you checked the order and the person who transcribed it, transcribed what was written without making mistakes.

[RochesterRN-BSN, BSN, RN]

You do bring up a good point....though I didn't realize you were speaking of a telephone order till half way through your post! lol --What you are saying does make sense.... My suggestion if they are making you do this.... If you are the second nurse signing... Notate this somehow along with your signiture, date and time.... "2nd check--Mary Smith, RN"...."transcription check, Mary Smith, RN"........something like this....I have seen this before and it would make you feel more comfortable see if you manager is okay with this. Talk to the individual that is the legal person for the hospital-- they usually have a lawyer that represents the hospital. Ask about this and how you can cover yourself legally and what liabilies you are at risk for and so fourth--what he/she recommends........they are the ones in the courts when legal complaints come up or mistakes are made that bring a law suit.....that may be your best bet.

Good luck!!

[APRN., DNP, RN, APRN, NP]

At many hospitals, there is a shift to shift (8hr or 12 hrs) check that the oncoming nurse does with the offgoing nurse. They both initial the orders that were taken by the off going nurse, and that takes care of the "double check".

[ozoneranger]

At one point we had some problem physicians recanting their phone orders. We instituted a 2 party phone protocol. 2 nurses had to hear the phone order, and.... the physician had to be told there were 2 nurses on the line.

It put a screeching halt to the problem, and 2 nurses knew what had been said, so safety was doubled.

[PsychNurseWannaBe, BSN, RN]

You do bring up a good point....though I didn't realize you were speaking of a telephone order till half way through your post! lol --What you are saying does make sense.... My suggestion if they are making you do this.... If you are the second nurse signing... Notate this somehow along with your signiture, date and time.... "2nd check--Mary Smith, RN"...."transcription check, Mary Smith, RN"........something like this....I have seen this before and it would make you feel more comfortable see if you manager is okay with this. Talk to the individual that is the legal person for the hospital-- they usually have a lawyer that represents the hospital. Ask about this and how you can cover yourself legally and what liabilies you are at risk for and so fourth--what he/she recommends........they are the ones in the courts when legal complaints come up or mistakes are made that bring a law suit.....that may be your best bet.

Good luck!!

Sorry you didn't realize what I was talking about until midway through my post. Was extremely tired. I'm better now... I got coffee! :chuckle Thank you for stating "transcription check" and the like because I was trying to think of some type of wording. It just makes me nervous that some how my little ole initals could get me in trouble when I didn't take the order to begin with. Maybe I can just put 2 check marks (double checked) and initials. Need something that is fast because we get a lot of orders. I don't have to initial the tele order...just the transcribed part on the POS. But then if there is a med change I have to review that. That is a lot of work when you are trying to take care of your own patients. Plus what a mess... we have 52 patients. Can you imagine trying to keep charts open long enough to get another to initial while fighting off people from taking the chart on you.

Oh well.. I am done with my rant and sincerely appreciate everyones input. Love this website and enjoy the camaraderie.

[miko014]

I was a little confused too...I didn't know if you were saying that you also listened to the order from the physician for a TO, or if you are checking off every order written or otherwise. I like the idea of 2 RNs listening to the order, but we can't have 2 people listening to the same line at the same time on my unit, so that would be a lot of repeating on the doc's part - not to mention the fact that it would be tough to hold another RN down long enough to get that done. We just do a "read back" with the physician before we hang up.

We do chart checks for the shift you worked - 4, 8, or 12 hours. Basically, the unit clerk takes off the orders, the RN verifies that they are correct, and signs them off. The next shift comes on and double checks what the first RN signed off - we actually catch quite a few mistakes. So if you are working a 12 hour night, you would go back and double check all the orders signed off by the 12 hour day person - make sure labs are in the computer correctly, meds are transcribed correctly, consults are called, etc. It can be annoying, but it's effective, and I think it sounds a lot better than doing it order by order. Also, the RN checking the chart is actually taking care of the patient and so is more able to tell whether or not the orders are appropriate. Hope that makes sense!

[CathyLew]

with phone orders, we have to do a read-back notation as well.

as far as the second nurse initial, it is to not only say that the order was transcribed correctly, but that the order was appropriate. It doesn't say the second nurse heard the order...but if you are an RN and signing or co-signing an order, it has to be an apropriate order. If the first nurse writes a T.O. for a tylenol dose for an infant that is too large a dose, and transcribes it correctly onto the MAR..... the second nurse is still responsible for verifying that the dose is a correct dose for the age/wt of the child. Not just that it was copied onto the MAR correctly.

same with double checking allergies. If I am going to co-sign an order, I need to make sure the allergies are noted on the MAR correctly.

[Whispera, MSN, RN]

Gosh, what are doctors for if we have to verify that what they ordered is correct for the patient?