Telephone orders...read back and verified...

[deespoohbear]

We were just told today in our staff meeting that we are suppose to read back telephone orders to the doctors and then sign it "read back and verified." I always read my orders back to the physicians when I take telephone/verbal orders but just sign T.O. Dr. Smith/B.Boop, RN. Boss said this is something that our lovely friends at JCAHO want and the state inspectors. News flash: I can write that to the cows come home, but if it comes down to brass tacks it is still my word vs. the MD's word about the orders. Gee, who thinks up this crap? If you really want it verified then there should be a third party on the line to witness everything. Otherwise it boils down to doc said/nurse said baloney.

Fortunately most of the physicians I work with are pretty decent about telephone orders. Since we are a small facility and such we get to know each other well. I guess other nurses aren't so fortunate and probably have ran into doctors denying they ever gave a telephone order even when they did. We only had one doctor that I didn't trust in that manner and I would always get a second nurse to verify his orders. (He retired several years ago, thank god. I really think the man was going senile).

Anyway, just more charting for us nurses....

[KaroSnowQueen, RN]

Yep, us too, started this fall.

TO: Dr. Frog/KNurse,RN/RV

Like that RV means squat. We can write it but does it mean the doc will admit if it 's wrong??? I seriously doubt it.

So many of our docs have thick accents, Spanish, Middle Eastern, Filipino. Some of them are very hard to understand, and if you ask a couple of them especially to repeat, they get ticked off, curse and hang up. Then you have to call back and really tick them off. Makes for a fun night.

[Mofe'ny]

Whoa, we had our survey mid february. Guess what! WE have a selfinking stamp that says, "Read back and verified, _______________ RN / LPN"

And with several doctors we have been told to have 2 people on the phone when taking any orders from these few doctors because they have a habit of denying the orders in the AM.

[FRN24]

I've seen a coworker of mine get into some real trouble over a telephone order. The nurse took an order for nitro, and then gave it. The patient had a reaction to it, so the next day the doctor denied ever having given the order. The doc refused to sign the order, and got the nurse into hot water over it. From the perspective of a future nurse, that was a shocker.

[Heather333]

Yep, we're doing to same thing. Have to right "Repeated and confirmed" after every verbal order (abbrevated R&C). It's a pain in the butt, but I can see how it could be useful.

Heather

[angelbear]

I agree with deespoohbear. I dont see how that would help if the MD is calling you a liar your writing that you read back and verified isnt going to change what he says. I actually put a MD on the speaker phone once because I did not agree with his order. So when I read it back to him to confirm I had him on speaker phone so my aids(no other nurse there) could hear what he said. Turned into a big mess. Dr never changed his story nor did he apologize to me. I never got in trouble or anything thanks to my witnesses but management destroyed my documentation on it. And yes I know that is illegal and yes it was reported to state. Anyway my point is had i just rbavto it would have been me against him and he would have won.(he kind of did anyway) Being a complete idiot I remained there another year.

[nimbex, RN]

Even worse!!!!!!! NNNOOOOO verbal orders unless in the middlel of a code or a proceedure. MD rounds and rattles off a list of things to do..... you tell them.... sorry, you have to write it.

All the MD's were alerted to this prior to going into effect.... yet some still try to get around it.

While a hassle, it does prevent the "I never gave that order" from occuring, which is happening.

The goal was to protect the patient and it also protects the nurses (until your staring at an angry glaring MD), but hey, it's Joint Commission rules.

just thought I'd share

[A Kitty RN]

Thanx everyone for the heads up-JCAHO coming next year and we don't have that rbavto going on. It doesn't seem effective though. Doctors always protect themselves first. We have alot of heavy accents at our hospital, too--so sometimes reading it back isnt' necessarily helpful--THe resident just says Yes, Yes. You wonder if they understand YOU sometimes. (sorry a little off topic)

[Overland1, RN]

We just completed the survey by the Joint (Smokers') Commission last year and they didn't mention anything like that.

.... and I thought I was being too verbose by writing, "Rec'd T.O. from Dr. _______ to ____________, RN:" and then numbering and listing each item of the order beneath that .

[baseline]

We had a discussion at work the other day after a HUGE no-no med error was made....not once..but twice. I know that short stafffing has alot to do with errors, but this was one of those that makes you stop and go "Hmmmmmm".

That being said, we got to talking about JCAHO. Point made, if we didn't make such glaring mistakes, and draw attention to ourselfs, maybe we wouldn't be so regulated. I know I'll get blasted for this but so be it. I said the same thing on the pain med thread awhile back. Rules are there for a reason. Duke is wishing with all their heart they had followed them. RB&V. No big deal.

[veetach]

JCAHO needs to spend one weekend working with me. Actually WORKING, not just observing. And then maybe they will get real.

No way do I read back orders... Not when I have 3 more docs on the phone wanting to give me more admission orders, a cardiac arrest rolling in the door, and a fresh MI coming in thru triage. NOPE no way.

[wolfie]

Many hospitals are dumping JCAHO From what I understand the Va hospitals have told JCAHO they don't need them. Why would you pay someone a huge amount of money to abuse you. Maybe they could use the money to give nursing personnel a raise:eek: What a thought:rolleyes: As far as I'm concerned JCAHO hasn't improved pt care over the years but just created more paper work which has taken the nurse away from the pt.

[deespoohbear]

Originally posted by baseline

We had a discussion at work the other day after a HUGE no-no med error was made....not once..but twice. I know that short stafffing has alot to do with errors, but this was one of those that makes you stop and go "Hmmmmmm".

That being said, we got to talking about JCAHO. Point made, if we didn't make such glaring mistakes, and draw attention to ourselfs, maybe we wouldn't be so regulated. I know I'll get blasted for this but so be it. I said the same thing on the pain med thread awhile back. Rules are there for a reason. Duke is wishing with all their heart they had followed them. RB&V. No big deal.

Was the error the result of a telephone order? Transcription error? Nurse overworked? Nurse not familar with the medication and regular doses? We have had med errors made because we can't read the physician's writing.....

We can't use the RB&V abbreviation. Has to be written out...read back and verified...which you can document until the cows come home but unless you have a 3rd party listening on the orders it just boils down to the physician's word to yours. Period.