Putting in orders

[C-lion]

I have become curious lately about the percentage of hospitals where doctors put their orders into the computer themselves. It seems like there is a much smaller margin of error and would save time compared to unit coordinators or nurses having to try to read their writing and put in orders.

Maybe I am missing the downside to this, anyone want to weigh in?

[KelRN215, BSN, RN]

When I worked in the hospital, the MDs entered their own orders. There were no paper charts unless the computers went down and neither hand-written nor verbal orders were accepted unless there were extenuating circumstances... but for the most part there was no need. A select few services did not have residents in house overnight but the on-call resident had access to the system via the VPN. Definitely better, IMO, than someone being the middle man and trying to decipher MD's chicken scratch.

[KeyMaster]

The downside in my hospital is that a lot of the MDs simply don't want to put in electronic orders. Many are older and although they may be comfortable with a computer they are not proficient with a keyboard, so order entry is time consuming and frustrating for them. When the docs actually do enter their own orders it does work well.

The nurses are not supposed to take verbal orders, but we are not supposed to refuse to either. Rather than hold the docs accountable, much time and effort has gone into devising ways to have the nurses enter orders, while making it look like the MDs do so that we can meet our meaningful use goals. We have lots of "protocol" order groups that RNs can enter and have the docs sign later. Or we take one verbal or phone order to enter a pre-built group of orders so the MD percentages for verbal or phone order entry are lower.

All in all it creates more work for the nurse because the unit clerks can't enter orders anymore and there are still a lot of docs who won't - guess who's left to do it.......

[MunoRN, RN]

The percentage right now is fairly small, but in the coming years it will be 100% of hospitals that take medicare thanks to the high tech act which phases in CPOE over the coming years. They will initially only need to have a small percentage of all orders entered by CPOE, but this increases in steps in the future.

[C-lion]

Thanks for the replies.

I am new to nursing, and hope to see a trend toward doctors entering their orders in the future. Where I am, the unit coordinators usually do it, but nurses are required to make sure it is done correctly. It is a small thing we are supposed to do during our shift, but it can take up more time than is necessary.

[CABG patch kid, BSN, RN]

At our facility there are a variety of ways this gets done, but all of our orders are supposed to be in our E chart. If you're lucky enough to have a unit clerk, they'll enter everything except meds; otherwise nurses put the written orders in the computer. We also have a hospitalist group that does a lot of direct order entry and that saves us a lot of time. It's taken some getting used to because sometimes those orders are easily overlooked if you're not vigilant with chart review. Can't wait until we've got more docs on board with this.

[eatmysoxRN, ASN, RN]

It's always frustrating when residents go behind and put in orders that contradict the ER docs orders. It would be great if they coordinated better. We still have both paper charts and CPOE. The delay is sometimes frustrating because the doc will say they'll put in an order for say.. Lunesta. Then 30 minutes later it's still not in so you have to call back and remind them. I wish I could write it myself at that point but we can't write orders for the residents. Otherwise I do like it. When it's completely implemented I may change my mind.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

[hiddencatRN, BSN, RN]

Where I'm currently working, we routinely have to take ADMISSION verbal orders. I can't even begin to describe how much I hate this, especially when they have electronic charting and the MD order entry system is available to all the physicians as long as they have internet access.

[RNperdiem, RN]

Out doctors adapted quickly. When you see a group of docs on rounds, there is an intern scooting around a comptuer-on-wheels or COW. After the patient is presented, the attending and residents give orders for the day, the intern types it into the computer and the orders print out ready for the unit secretary to transcribe or the nurse to check.

Drug orders go straight to the pharmacy and lab slips get printed from the computer orders.