Verbal orders for narcotics

Nurses General Nursing

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The day shift nurse, who had left for the day, called the patient's MD from home and got verbal orders for PRN narcotics for a patient on a sub acute floor. I'm supposing she didn't have time to do this during her shift. This nurse then calls the nursing supervisor and gives her the orders. The supervisor writes them down, and passes them on to the 2nd shift floor nurse who has that patient with the request to write the orders. The orders were for four narcotics, including OxyContin.

What would you do? It's not possible at this point to reach the doctor personally.

You have clearly never worked in a small town hospital.

You mean, in a small town a nurse has the doctor's number at home, but the nurse's at the facility don't? I'm not buying that. Even in small rural areas, facilities have to have a way to get ahold of the doctor who is currently covering the facility.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
You mean, in a small town a nurse has the doctor's number at home, but the nurse's at the facility don't? I'm not buying that. Even in small rural areas, facilities have to have a way to get ahold of the doctor who is currently covering the facility.

Lots of wonky things happen in small towns. Particularly with ****** cell phone reception. I'm just saying, I would not automatically assume it's a test question. I could tell you some ridiculous stories.

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Lots of wonky things happen in small towns. Particularly with ****** cell phone reception. I'm just saying, I would not automatically assume it's a test question. I could tell you some ridiculous stories.

I don't think the DEA or the State Board of Nursing care if you work in a large city hospital or a small rural hospital? It is up to every nurse to do what they need to do to protect their license.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
I don't think the DEA or the State Board of Nursing care if you work in a large city hospital or a small rural hospital? It is up to every nurse to do what they need to do to protect their license.

You misunderstand. I'm not saying it's RIGHT. I'm arguing with the person who said that this scenario could never happen and she thinks it's fake and just a test question. I'm saying, I've seen crazy **** just like this happen in small town hospitals. My only point was that I don't necessarily think it's a made-up scenario.

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You misunderstand. I'm not saying it's RIGHT. I'm arguing with the person who said that this scenario could never happen and she thinks it's fake and just a test question. I'm saying, I've seen crazy **** just like this happen in small town hospitals. My only point was that I don't necessarily think it's a made-up scenario.

Oh no, sorry, I didnt think you were saying the situation was okay. I totally understood where you were coming from.

I am just pointing out that its up to us as nurses to uphold the standards, even when others dont want to, if for no other reason than to selfishly protect our licenses. Because if the DEA or the BON start investigating, those same hospitals and doctors who pressured you to comply, will throw your butt under a bus in a heart beat.

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Specializes in PACU, pre/postoperative, ortho.
You have clearly never worked in a small town hospital.
Even then, at my small hospital, we escalate it to the chief medical officer for orders via the nursing supervisor. Had that happen once in a situation during the night when the MD would not return his pages. Didn't have any more trouble after that with getting a return call from that particular doc! Eta: Reading further about having the phone number at home. That is entirely believable here. Everyone knows everyone, related to everyone, etc. The docs hold large parties on holidays inviting staff. Our medical chief has a big memorial day cookout coming up & passes fliers to all depts. In the past, he has invited people to just bring tents & camp out on their lakefront property when they hold events. He's also married to a long time charge nurse on one floor who is close friends with a lot of staff who socialize regularly with them & other docs.
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Specializes in Mental Health, Gerontology, Palliative.

Oh hell no.

I would only take a verbal order directly from the doctor. And it would have to be a doctor that I have worked with before and that doesnt mind repeating the order for a second checking nurse and can come into the facility within 24 hours to sign the verbal order

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Lots of wonky things happen in small towns. Particularly with ****** cell phone reception. I'm just saying, I would not automatically assume it's a test question. I could tell you some ridiculous stories.

I would not think a facility would be calling from a cell phone. The nurse at home calling would maybe have wonky reception, but the facility should not. This scenario makes absolutely no sense.

I'm sure some RNs have physician phone numbers, but stating that the facility has no way to get this doctor when another RN does makes no sense. Thus, a poorly worded homework question.

And yes, I've been in a small community rural hospital before. There was still always a physician on call. Always.

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Specializes in Geriatrics, Dialysis.
If this was an outpatient prescription, yes. However, not the case in the hospital. I never did like taking an phone order for opioids, but, especially at a community hospital, it was a necessity. I never really had an issue getting ahold of a doctor, but if that was "private" physician, he is not going to drop everything while out to dinner to find a computer to put in an order for meds. Doctors aren't going to get out of bed during the middle of the night to enter an order. To everyone who says that they will "never" put in a phone order for pain meds--in theory that sounds really good. If it is 6 pm, I'm not going to let my patient sit in pain for 14 hours until the MD rounds the next morning. Stand up to the doc and say "no, policy is for you to put them in?" On principle that may be right, but, especially in smaller hospitals, my experience is that every dispute is decided in favor of the doctor.

Pharmacy will fill narc orders where you live without a written Rx? Must be yet another one of those things that vary state to state. I thought that was a federal rule, apparently not. I do know that in MN they can only fill a small emergency supply of a schedule 3 and 4 med until a written Rx can be obtained, and only then if the verbal order is called in to pharmacy by the provider. They will not fill schedule 2 meds at all without a written Rx so that oxycontin wouldn't have been filled unless the provider got that written Rx to pharmacy.

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Specializes in Emergency, Telemetry, Transplant.
Pharmacy will fill narc orders where you live without a written Rx?

I was referring to a hospital pharmacy accepting a VO/TO for a narcotic, which, yes, they will accept. Retails pharmacies must have a written script. I have never heard of retails pharmacies in my area being able to give an emergency supply.

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Specializes in Geriatrics, Dialysis.
I was referring to a hospital pharmacy accepting a VO/TO for a narcotic, which, yes, they will accept. Retails pharmacies must have a written script. I have never heard of retails pharmacies in my area being able to give an emergency supply.

I work in a SNF so it's not exactly a retail pharmacy. It is an off site pharmacy that serves several facilities across 3 states. The home office is in Minnesota so they abide by Minnesota regulations for dispensing meds

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