How are drug orders handled at your facility?

TheCommuter, BSN, RN · Jan 11, 2007

1. Written medication orders - If the doctor has written and signed the order during his/her rounds, I will clarify it if necessary, fax the order to the pharmacy, transcribe the order onto the medication administration record, document that I notified the responsible party of the new order, and await the arrival of the medication from the pharmacy. I will administer the initial dose if the medication arrives during my shift; also, I document the patient's reaction to the newly-ordered medication for 72 hours. I notify the oncoming nurse(s) of the new order within the 24-hour patient report at shift change.

2. Verbal/Telephone Orders - I handle verbal and telephone orders similarly. I will read and repeat the order back to the physician/PA/NP to ensure it is accurate. I will transcribe it onto a physician's order carbon-copy slip with the acronyms V.O.R.B. (verbal order read-back) or T.O.R.B. (telephone order read-back) and fax a copy to the pharmacy. As usual, I'll transcribe the order onto the medication administration record, document that I notified the responsible party of the new order, and await the arrival of the medication from the pharmacy. I will administer the initial dose if the medication arrives during my shift; also, I document the patient's reaction to the newly-ordered medication for 72 hours. I notify the oncoming nurse(s) of the new order within the 24-hour patient report at shift change.

Daytonite, BSN, RN · Jan 11, 2007

1. at your institution, what are the nurse's obligations for carrying out a written medication order?

the nurse is responsible for making sure the order has been noted and properly carried through. this means that i need to check to make sure that the unit secretary has notified the pharmacy and that the medication order has been properly transcribed onto the current medication sheet. if i am the patient's nurse then i know about the new medication order if i have noted the physician's order. if i am acting as the charge nurse, then i need to communicate to the patient's nurse for the day that there is a new medication order and what it is.

2. a verbal order?

verbal orders can only be taken by rns. these orders are often given during discussions with doctors. sometimes the doctors just forget to write the orders. doctors are supposed to know not to give orders to anyone but rns, but sometimes they say things to workers not realizing that they may not be rns. an rn who hears or takes a verbal order should immediate write it in the patient's chart noting the date and time as "v.o. [for verbal order] dr. xxxx/n. nurse, rn". the order is then carried out and signed off like any other written order. the doctor has 24 hours to sign a verbal order in the acute hospital where i worked.

3. a telephone order?

if a doctor is calling the order in, any rn can take the order. however, it really is best to ask the doctor what patient he is calling about and get that patient's nurse to take the order since they know the patient and can question the doctor if there are any other concerns. it's a good idea to write the order down and repeat it back to the physician to verify that you have gotten it correct before hanging up. after hanging up you need to write the order and it's date and time in the chart immediately followed by "t.o. [for telephone order] dr. xxxx/n. nurse, rn"

4. a standing order?

even though we have standing orders, we have to have a written order from the doctor that it is ok to use certain specific standing orders. when i worked on a stepdown unit we always got an order, or the physicians wrote "ok to use standing orders for arrhythmias". then, we could treat the patient if they had any type of arrhythmia that we noticed on the cardiac monitors. for hypoglycemic protocol we often went ahead and wrote "standing orders for hypoglycemic protocol" and got them approved ahead of time if we knew the patient was diabetic. if we had a patient go into a hypoglycemic reaction who did not have these orders, we were on the phone to the physician immediately while we were already calling the lab and opening up a box of 50% dextrose for iv push in anticipation of the order.

5. a prn order?

can be instituted at the discretion of the nurse and if the nurse is aware such an order exists. it needs to be noted in documentation in the nurses notes to verify why the order was carried out.

6. does the type of prescribed drug affect the order? if so, how?

there are certain medications that can only be given by the nurses in the intensive care areas. there are certain medications that cannot be given by any nurse at all. there are some medications that we can only give orally but not iv. these are all listed in the policy manual.

7. what special procedures and documentation are used for experimental drugs as part of a clinical trial?

whenever we've had anyone on a clinical trial, we've been given information about the drug for others on the nursing staff to read. the patient usually has signed a special consent and this is in the chart. we are usually given a special list of specific side effects to look out for. we also have a special form to note these on that is in the patient's chart. sometimes we only know the name of a drug by a number.

8. what are the potential consequences of not following a medication order if it was correct? if it was incorrect?

an incident report needs to be filed. the nursing manager usually addresses these with the individual employees involved. it is up to the manager as to whether disciplinary action is going to be taken. if a medication order is wrong it is up to the rns to immediately contact the doctor and get the order clarified and document their efforts in doing this. if an error in transcription is discovered, it needs to be corrected immediately and an incident report filed.