Doctors never sign Verbal or Phone Orders

pagandeva2000, LPN · Sep 17, 2008

I work in a clinic, so, this doesn't happen as often, but when it does, it is uncomfortable. What happens in my case is that a doctor (usually a resident) will verbally tell me to administer a clonidine and suddenly, I see no orders. I now say to them "No written order, no pill"...period. Started going to their attendings or preceptors and it slowed down, at least for me.

woknblues · Sep 17, 2008

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.

what a joke. let em' earn their money. boo hoo, they have to do paperwork. we all do.

classicdame, MSN, EdD · Sep 17, 2008

if your facility is surveyed by JCAHO you can contact them anonymously and report this practice. They will handle it from there. Meanwhile either put the doc on speaker or get a witness on another line to pick up (telling MD what you are doing of course). Risk management might want to know that policies are not being followed. Go up chain of command. In my state, if you follow chain of command, then call safe harbor (form to complete online) then your license is safe.

SAC101 · Sep 17, 2008

Resigning may not be your best option. Just make sure you do proper documentation whenever you receive telephone orders. You never know the hospital next door may just have the same doctors practicing there. Are you going to quit again?

smk1, LPN · Sep 17, 2008

It is a joint commision standard that they be signed within 48 hours. The hospital needs to come down hard on the providers who are not in compliance to fix the issue. This is NOT a nursing responsibility. Yet we get emails all the time about "our" compliance. At some point providers have to be responsible for their own paper work. I probably sound a bit cranky on the subject, but it is irritating that somehow hunting providers down to fulfill their job requirements is becoming a function of my nursing practice. Not cool.

DrugReptoNurse · Sep 17, 2008

I checked a chart today for a patient who has been in the unit for over a month. None of the phone orders had been signed off on by the docs. I brought it to my managers attention and was told "the hospital doesn't want to offend the docs by asking them to sign off on their verbal orders".

That was the last straw for me. It leaves me in legal limbo if a patient's chart ever goes to court. I resigned five minutes after confronting my manager. The new hospital where I will be working requires the physicans to sign off on their phone orders. They have a red "sign here" sticker for each verbal order. If the physicans don't sign off they lose the right to practice in the hospital. The new hospital is non profit Level I trauma state teaching hospital. The old one was a for profit hospital. From what I am told there is little to any overlap in physician coverage between the two hospitals.

I'm just not willing to let my license and my livelihood be forfeited by the refusal of physicians to sign off on their phone orders.

CoffeeRTC, BSN, RN · Sep 17, 2008

this was common in my LTC. Docs would only come in once a week, some not even that. We fax them all the T/O and they have 48 hrs to sign them. After that the medical director gets after them or signs for them.

woknblues · Sep 18, 2008

I checked a chart today for a patient who has been in the unit for over a month. None of the phone orders had been signed off on by the docs. I brought it to my managers attention and was told "the hospital doesn't want to offend the docs by asking them to sign off on their verbal orders".
That was the last straw for me. It leaves me in legal limbo if a patient's chart ever goes to court. I resigned five minutes after confronting my manager. The new hospital where I will be working requires the physicans to sign off on their phone orders. They have a red "sign here" sticker for each verbal order. If the physicans don't sign off they lose the right to practice in the hospital. The new hospital is non profit Level I trauma state teaching hospital. The old one was a for profit hospital. From what I am told there is little to any overlap in physician coverage between the two hospitals.
I'm just not willing to let my license and my livelihood be forfeited by the refusal of physicians to sign off on their phone orders.

Well, you certainly have convictions. I hope that your departure will evoke some change in the place you were. Feet seem to vote better than any ballot or reform. The place I left (non health care) for a number of reasons immediately hired two people to do my job. I left on "good terms", but I am glad for the rest of the crew, that management was forced to "do something about it", rather than taking advantage of someone else's good nature and work ethic.

Practicalone, LPN · Sep 18, 2008

Where I work, the docs ve 24-48 hours to sign the orders, if they don't sign them, the chart gets walked to their office and they have to sign it in front of the director of records. But that only happens on rare occations. for the most part, they are signed at rounds in the am or pm