Doctors never sign Verbal or Phone Orders

[DrugReptoNurse]

I'm working at a hospital where the practice of physicians not signing verbal or phone orders is the norm. The hospital has a new policy where verbal orders are no longer allowed. They have to be from the phone. We now have doctors in the unit picking up a phone and paging us so they can give us a phone order. I don't like that practice but I can live with it.

What scares the hell out of me is that these physicians never sign off on their phone orders. The adminstration is aware of the situation and won't force the physicians to sign off. They are afraid the doctors will decide to go practice somewhere else.

I have nightmares about being called into court regarding a phone order. The attorney asks" Dr. so and so, did you phone this order in that nurse Jones wrote?" The doctor can deny it and I have no proof to back up my claim that the doctor phoned in the order.

I am considering resigning a rather new position because of this. I need to protect my license and prevent an overzealous attorney from suing the crap out of me because of a verbal order the doctor wrote.

Am I wrong to get nervous about this practice or am I over reacting?

All replies appreciated.

[TheCommuter, BSN, RN]

You're not overreacting. These physicians need to sign the telephone orders.

[Batman24]

You have good and valid reason to be nervous. The orders need to be signed.

If your manager won't take action you should make Risk Management aware. They'll care. This is a lawsuit waiting to happen.

[FroggyMama]

Do they just not sign the paper chart? Some of our docs go in and digitally 'sign' on the computer after the chart has been sent to medical records. Or is that not being done either? I'd call the state in about it.

[DrugReptoNurse]

It is a hospital wide problem....in all departments. Risk Management knows. The nursing supervisors have been told this a problem for the executives of the hospital and the doctors to work out.

I didn't know this was the case when I started working there. In my next nursing job interview I'll be sure to ask if the docs sign off on their telephone/verbal orders that are written by RNs

[DrugReptoNurse]

The unit where I work does not have computerized charting yet. Everything is done on paper. The docs will not sign off. I have asked them to and was told by a number of them that they don't have the time.

[whipping girl in 07, RN]

Every hospital I've worked at had a process where orders had to be signed. If they weren't the doctor could lose his/her privileges. Ideally they are signed the next time the doctor was in the chart. The Joint Commission's NPSG says within 48 hours. It's not an option. It's not something to "work out." Your hospital should have a corporate compliance or corporate integrity department if they get Medicare/Medicaid reimbursement. Do you have a Joint survey coming up? Might be a good thing to mention to the surveyors. If you can't get anywhere in house, take it to the state.

[TheCommuter, BSN, RN]

I know a physician in my city who has lost privileges at multiple hospitals due to having a massive backlog of unsigned telephone orders, DNR forms, and other paperwork. At this time, he has admitting privileges at only one hospital.

[core0]

I know a physician in my city who has lost privileges at multiple hospitals due to having a massive backlog of unsigned telephone orders, DNR forms, and other paperwork. At this time, he has admitting privileges at only one hospital.

This is the norm. In most hospitals the chart is flagged by medical records and placed aside. The physician is notified that they need to sign the chart. If the chart is over a certain number of days old (usually around 60) they are reported to the medical staff and receive a notice that they will be suspended if they do not get into compliance. Its actually a bid deal since one of the questions on a state license, insurance renewal or credentialling app is "have you been suspended from any hospital staff"? There is no difference between being suspended for ETOH and charts.

David Carpenter, PA-C

[lpnflorida]

We have much less of a problem with this occuring. Putting those darn red sticky flags next to the orders which need to be signed has helped. that and we remind the couple of physcians who seem to like to ignore them for a few days. All in all, even if it goes on and patient is discharged medical records deals with the doctors over it. Yes, they lose the priviledge of being able to admit new patients until their records of prior patients are up to date with everything signed. They really hate spending hours and hours doing that down in medical records.

Doctors know it is their responsiblity. It sometimes becomes our responsiblity to put the chart in front of them and say sign this. I hate having to do it. But I will, if necessary.

[zodiac]

Shouldn't be this way. Where I work MDs are fined if telephone/verbal orders are not signed. Our ANM also audits our charts every am to make sure these orders are signed.

[NursingAgainstdaOdds]

This was a huge problem for us until JCAHO came through and we got totally nailed for it. So, administration came-up with these enormous day-glo orange stickers and did a little "education" with the physicians. It's not something we have to worry much about anymore ...