Taking admission orders over the phone.

[YippiNurse]

I just recently started working in a trauma 2 ED and often ED docs give me thier phone so admitting docs can give me the admission orders. I have to stop everything I'm doing (I'm usually in the middle of doing 3 things at the same time) to take these orders. Meanwhile the docs/residents are at the desk talking or already on the computer. Is this normal at other EDs? Aren't the docs that have seen the patients in better position to enter these orders including medications & labs, not to mention they enter orders all the time? How does it work in your ED? Just a little frustrated!

[RN1989]

Admit orders should be faxed. Too much liability and room for error calling in a page or two of admit orders.

[bill4745, RN]

We take verbal orders. We have tried to change it but they won't give in. We used the policy that verbal orders are only for emergencies; is admitting a stable with pneumonia an emergency? I don't think so.

Our way of fighting back is to take a long time to find blank order sheets, and to not have a list of patient's meds - this frutrates the heck out of the admitting docs.

[SheriLynnRN]

Our way of fighting back is to take a long time to find blank order sheets, and to not have a list of patient's meds - this frutrates the heck out of the admitting docs.

This sounds pretty passive-aggressive to me. IMHO, it's always better to be direct than to resort to cattiness. These are the kinds of behaviors that lead to a breakdown in communication and collaboration between docs and nurses, which leads to care that is less safe and of lower quality. Of course it's frustrating when they expect us to be their personal secretaries, but this way of addressing the problem is unprofessional.

[northshore08]

In one ED, the doc who did the majority of admissions would leave pts in the ED awaiting admit orders, then call about 1700 and want to give orders on the 4 (or more) pts waiting for orders. When the ED docs heard he was on the phone, they would hand over all the charts of potential admits for us to get orders. I have taken phone orders for as many as 6 patients at one time.

Of course the pts did not make it up before 1830.

My favorite doc of all time said,"Admit with dx of ; floor nurse to call for orders." Yeehaw!

[bill4745, RN]

This sounds pretty passive-aggressive to me. IMHO, it's always better to be direct than to resort to cattiness. These are the kinds of behaviors that lead to a breakdown in communication and collaboration between docs and nurses, which leads to care that is less safe and of lower quality. Of course it's frustrating when they expect us to be their personal secretaries, but this way of addressing the problem is unprofessional

I understand your point, but nothing else has worked. We all have cell phones in the ER. There are times when I am starting an IV and my phone rings with a doc wanting to give orders. I get calls transfered to me with:

"This is Doctor Smith. I need to give orders"

"On which patient?"

" I don't know. The patient Doctor Brown just called about".

[TraumaNurseRN]

I understand your point, but nothing else has worked. We all have cell phones in the ER. There are times when I am starting an IV and my phone rings with a doc wanting to give orders. I get calls transfered to me with:

"This is Doctor Smith. I need to give orders"

"On which patient?"

" I don't know. The patient Doctor Brown just called about".

I don't think it is caddiness at all. If I am busy...I'm busy and it's not fair for me to leave the patient I am caring for to do something the admitting doc is too lazy to do. I did not get my nursing license to be their secretary. We have had problems in the past and recently all the calls have transferred to the PCS/supervisor and that has helped quite a bit.

[LMPhilbric]

We take basic orders, diet, activity, labs, meds that can't wait to get the patient through until the doc can get there. I don't want my docs writing orders. Then I get phone calls from the nurses upstairs who can't read the writing or want to know why my absent-minded-professor doc wrote an order for "Toprol XL 25 mg" (that's it, no route, no frequency, no nothing). I least my orders are legible and correct.

[helloworld]

In my hospital we have residents and interns and NPs that come down to write admission orders. They see the pt, do the H&P, and write orders then page the admitting doc to verify the orders, so all we have to do once they're done is look through the orders, do anything that is labelled STAT or NOW, and then send the patients up.

We have a policy that we only take verbal orders (like if a med needs to be changed because a pt's condition is changing or something like that) only if it's an emergency.

Works really well.

[JBudd, MSN]

If the patient is being admitted by the hospitalist (or residents with them), they are there writing them themselves.

On the not very often case when they are getting admitted by a private doc or service, letting them call the orders in to me speeds things up a lot, rather than waiting for the doc to be able to come in. It is usually just basic dx, diet, meds and AM labs. The doc then comes in after office hours or in the morning (I work nights). I don't really mind, because I want the patient to be able to move as soon as possible. Our docs just ask another nurse or the charge if I am busy in a room, any of us will take orders for a coworker if we are at the desk.

Our hospital policy won't let the ER docs write the admit orders, there used to be a lot of problems that disappeared with the new policy.

[Roy Fokker, BSN, RN]

If the patient is being admitted by the hospitalist (or residents with them), they are there writing them themselves.

On the not very often case when they are getting admitted by a private doc or service, letting them call the orders in to me speeds things up a lot, rather than waiting for the doc to be able to come in. It is usually just basic dx, diet, meds and AM labs. The doc then comes in after office hours or in the morning (I work nights). I don't really mind, because I want the patient to be able to move as soon as possible. Our docs just ask another nurse or the charge if I am busy in a room, any of us will take orders for a coworker if we are at the desk.

Our hospital policy won't let the ER docs write the admit orders, there used to be a lot of problems that disappeared with the new policy.

Same here.

Our admitting docs are really nice though.

cheers,

:)

[samantha11]

In our ER the MDs give the admitting docs the disposition and hand the phone over to which ever RN is close by. We have sleeping docs who drop the phone, we have the whispering docs that don't want to wake their spouse and the docs that call our ER MD "that idiot" and vent. Talk about fun, fun, fun!