Is it ok to take Verbal Chemo Orders

[monalunaxo]

Hi All,

I have been an Oncology RN for over 4 years now, in my current position I work as an infusion RN at an Outpatient clinic. I am being asked to take verbal orders for chemo and enter them and also to modify current chemo orders that are entered and adjust their doses or instructions.

I have never been asked to do this before and I was always trained that it is not within the RN scope to take verbal orders for chemotherapy period, whether it is oral or not.

Can't find anything in the ONS handbook, wondering what you all think or know off hand? Thanks for your help!

[Rose_Queen, BSN, MSN, RN]

I don't know of anything specific to chemo, but I know that my facility has a policy banning verbal orders except for in emergent situations and from a surgeon who is scrubbed in. If it's a verbal order, the physician is already present and can place/modify the order his/herself. Or did you actually mean telephone orders?

[monalunaxo]

I mean verbal orders by phone or face to face re entering a new oral chemo order or modifying a current oral chemo order

[Rose_Queen, BSN, MSN, RN]

Verbal by phone = telephone order. That's a whole different category where I work. Again, not specific to chemo, but for telephone orders, the nurse taking it is to remain on the phone with the physician until the order is completed so that any popup warnings or issues can be taken care of without additional back and forth paging/calls.

Face to face = physician present on unit. There's a computer, put it in yourself. That's the policy.

Have you looked up your facility's policy in regards to verbal and telephone orders in general? What about policies specific to chemo?

[adventure_rn, MSN, NP]

That sounds like a sentinel event waiting to happen, especially since chemo has such a narrow therapeutic index. Even if it isn't officially against your facilities policy, it probably ought to be.

[Trixie13, BSN, RN]

Nope, nope, nope!! Policy at my facility is that chemotherapy orders are written/entered, NEVER verbal. Offices that aren't online fax orders. Even if orders are modified the provider does it. We only verify. Pharmacy wouldn't even touch orders without a provider's signature.

[ONCRN1977]

My facility and many others require paper orders for chemotherapy. Under no circumstance are we to accept chemo orders in any other form. As mentioned earlier the chance for a SSE is very high.

[Nurse Beth, MSN]

Agree with everything Rose Queen and others said about verbal and telephone orders in general.

I have my ONS chemotherapy certification and we partner with UC Davis in our oncology line. Our facility's policy is no telephone order for chemo, except to discontinue chemo.

We use pre-printed chemo orders as we have not yet built electronic order sets in Cerner for chemo. A chemo certified nurse must note the orders. Hope this helps.

[DowntheRiver]

I work for a top ranked CCC and we are not allowed to take verbal orders. If the doc is away from the computer (like physically not in the office or not at home) we can take orders for something like a CBC but never changes in chemo.

[DeeAngel]

Most facilities anymore have polices that verbal orders are supposed to be infrequent and only in urgent situations. I would not take an order for chemo over the phone, it's the doctors responsibility to write this order, its what they are being paid to do.

[NurseLatteDNP, MSN, DNP, RN]

I work for one of the top 5 cancer hospitals in the US and we do not ever take verbal or telephone orders for chemo. We have several inpatient and outpatient oncology buildings and all function the same way. The ordering physician has to be in town while the patient is receiving chemo.

[Daisy4RN]

I would never take Verbal orders for chemo. Just like any other verbal order, if something goes wrong who do you think will be held responsible! If you are getting push back from your admin then check the policy, if it does indeed say that you can take VO for chemo (which I doubt) I would always have it read back and verified by the Nurse Manager or Charge RN and document that myself and have them document also. Obviously it is much safer and simpler to just have the MD write the order. Even with the 2nd RN verification I would not be comfortable taking a VO for chemo (and I have worked Oncology).