Doctors telephone orders???

THis is how I do them....

"Telephone order as of 1657 on Tuesday September 12, 2005 from Dr. Ima Dolt at (phone number used). ((If it is an on call..I say Dr. Norest oncall for Dr. Ima Dolt)

1. R/t hyperglycemia, give 12 units of Regular insulin STAT SQ.

2. Wait 30 minutes and take a CBG.

3. Contact Dr. Ima Dolt again if CBG above 300 or below 70 for further orders.

4. If patient becomes unconscious or worsens, use 9-11 for transport to nearest hospital.

X________________________ (Physicians Signature)

Please respond with signature within 24 hours.

and my signature with title and the time and date.

I fax this to the physician, and copy it for orders in the chart and other nurses.

BUT that is my own facility policy...check with yours..they may differ.

We have to have two registered nurses listen to the order to verify it... or at least that's how it was when I worked on the wards!

Two RN's??? Wow, that seems interesting! From passing a state board, and being an actual RN, I have the ability to take a MD order on the phone with no probelm on my own! Kinda the reason I got that pesky RN LOL!!!!!

BUT I will admit...the first 20 or so I took as a new nurse....I didn't know the questions to ask or clarifications that may be needed like I do now...so that wouldn't be a bad idea to pair up a newer nurse or one not use to telephone orders with someone experienced!

Nothing more embarrising than calling back that MD at 0300 saying...ummmmmm did you mean PO or SQ? LOL!!!!!!1

We have started a new protocol concerning phone orders and verbal orders

When taking the order we now write VORB or TORB which stands for

Verbal Order Read Back and Telephone Order Read Back.

we do it like this:

9-12-05 1700 Ultram 50mg PO q6h PRN for pain

VO Dr. Dingbat/RB J. Doe, RN

the VO being verbal order (duh) which goes for face to face verbal order or over the phone, then RB is read back, because we are required to read back the order to teh doc.

We have a form in patients charts that we write on. We have to put the facility name, patient name, doctors name, our name and sign it, note that you changed the mar, notified pharmacy, family and that we charted it in the nurses notes. It is a 3 carbon, one to pharmacy, one stays in the chart and the top goes to the doctor to sign. We don't have to have anyone listen or cosign.

I love the check off list!!!!!!!!! Especially "changed the mar". I have an older nurse that forgets to either sign her order changes on the MAR, or forgets to take the old meds out of the cart (I work assisted living where cargivers/CNA's do med pass) and that can mean life or death!

When I get a telephone order I copy it for the chart, and in red pen I mark what I did. Contacted pharmacy, changed MAR, removed old meds (if applicable), and recieved new med and correct! This is not a policy, but I do it to safe time, save patients, save money and CYA!!!!!!!!!!!!!!

Again..I am not one to leave alot to change..a controlled..oh boy you don't even want to know all the extra stuff I do to CYA! LOL (remember assisted living, so there isn't two nurses to count or bring in...so I do alot to ensure it is right, that I know that MD signature (that is a toughie big time), clear with pharamacy, and put it into the lock myself!!!!!!!

We have a duplicate form with all the info written up down the side ie: name of resident, Dr, facility and signature of person who processes order. Then we write the date, time and order and also put TO Dr. Blank/Joe Doe RN or VO for verbal order. We have a stamp which we stamp on the order with MAR,Pharmacy,Pull,Lab which gets ticked off as you do it.

Ours is simply the order with the signature line: T.O. RAV Dr. Whoozit/Nurse signature, RN

RAV = Read back And Verified and the Drs. are trained to look through the chart each day w/rounds and sign behind.

A lot of places have two nurses listen when taking a telephone order...not because we are stupid or anything but because too many nurses have been screwed when a doctors laters says..."I didn't give that order," or "I would never say to give _____ every ___ hours!"

Our healthcare organization requires:

09/15/05 0900 "Ativan 0.5 - 1.0 mg PRN anxiety"

R.B.V.O. or R.B.T.O. from Dr. John Doe to Jane Doe, R.N.

RBVO = Read back verbal order RBTO = Read back telephone order