Taking admission orders over the phone.

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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!

:banghead:

When the ED doc hands me the phone I very politely say, "Dr____, please hold while I get the nurse." and promptly transfer the call to the floor. (I just need to make sure I know which floor :])

Works about 99% of the time.

Bonus is that the floor now knows they're getting a patient and what has been ordered.

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When the ED doc hands me the phone I very politely say, "Dr____, please hold while I get the nurse." and promptly transfer the call to the floor. (I just need to make sure I know which floor :])

Works about 99% of the time.

Bonus is that the floor now knows they're getting a patient and what has been ordered.

AWESOME IDEA!!!!!!!!!

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AWESOME IDEA!!!!!!!!!

Yeah, if you're the ER nurse. Not so awesome for the floor nurse. It's nice to know you're getting a pt, and a little info about them...like their NAME, for example....before the doc is on the phone trying to give admit orders. Geez. :banghead:

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Yeah, that sounds about right. I currently work in two different ERs, both have computer systems but only one computer system has the ability to enter the orders 'online'. The other still uses paper orders. I worked at a level 2 and they could care less what you were in the middle of doing, the world stops turning when a Doc calls for orders. and if you don't get to the phone in time, they will hang up. And then if you have issues/problems with your pt that the ED Doc won't address it since he has already 'transferred' care over to the admitting Doc, then you are just screwed until admitting Doc takes his sweet time calling back. Glad I don't work there anymore. The one Er that I work in now with the "computer entry" orders currently has a list of "offenders', Docs who call in to give verbal orders instead of using their hospital issue palm pilot to enter orders from home or wherever. if they are on campus, they are required to enter the orders themselves. but they manage to find ways to give verbal orders because I swear the other day I had just seen one of the family med docs and he was calling me on his cell phone with orders, it just slows the whole process down.

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Specializes in ER.
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!

:banghead:

done that many times - hated every minute of it. That hospital where I worked didn't have hospitalists - now where I work, we just wait forever for the "list" to be checked off by the next hospitalists. There are so many I don't know who is where or in what order. I don't know what you mean by: "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?"

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Specializes in ER.
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.

well if you're in the middle of something (or three) and your ER doc hands you the phone for orders (usually not on a patient of yours even), you DO take a moment to grab an order sheet. And you don't have time to find a chart with a person's meds, because you're trying to write it quickly and move on and put that nitropaste on your own patient. It's incredibly intrusive for the nurse and rude by the admitting doc who could just come on in and take his or her time to write the orders. They ought to come in also to review all labs just in case they need to add on anything anyway, since most ER docs only give enough info to get a patient admitted. Just my thoughts.

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Specializes in ER.
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!

or the admitting GI doc who's in the bathroom ON THE TOILET giving orders and you hear all sorts of sounds.... :down:

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Specializes in ER.
When the ED doc hands me the phone I very politely say, "Dr____, please hold while I get the nurse." and promptly transfer the call to the floor. (I just need to make sure I know which floor :])

Works about 99% of the time.

Bonus is that the floor now knows they're getting a patient and what has been ordered.

how can you do that if the patient is in the ER, before they've gotten to the floor? Don't you have to have admitting orders to get to the floor? I've never heard of a floor nurse taking orders on a patient not yet there....

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Specializes in ER/Trauma.
how can you do that if the patient is in the ER, before they've gotten to the floor? Don't you have to have admitting orders to get to the floor? I've never heard of a floor nurse taking orders on a patient not yet there....
I've taken orders on "direct admits" plenty of times.

cheers,

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Specializes in Emergency, outpatient.

ED nurses take orders routinely on patients whom they know NOTHING about. But wherever I've worked, the bed people had to have a name, age, dx and type of bed required before issuing any assignment of which floor or bed.

We recently instituted CPOE (computerized physician order entry, for those unfamiliar--all docs put in their own orders) and I had my first verbal admit orders yesterday. I learned a couple of lessons. #1--It is best to refuse to take verbal orders if possible. (Not the few ED ones--I am talking the whole list of admission orders) It took me no less than 1-2 hours with direct hands-on assistance from computer personnel for me to enter the physician's orders correctly. #2--If I have to take the orders, I will sit at the computer, pull up the screen, and read every line to the physician for verification. (One episode of that should bring verbal orders to a screeching halt; my charge nurse was not happy that I was required to take the orders.):argue: The doc who handed me the phone apologized repeatedly; I think when the ED docs see what happens, they will deflect the verbal order requests. One can only pray.

I tried to do written ones on our old format like it used to be, and send it with the patient to the floor, but that requires the nurse on the floor to sit and go through what I was trying to avoid in the ED. So I got bit this time,:angryfire but next time it will be "aren't you able to enter these? You know I am required to put them directly into the computer, and if I don't I will have to call you repeatedly over the next 2 hours to clarify every pharmacy override, missing order, etc, etc...." "Yes, I really think you should either come in, do these at your office or get the hospitalist to admit for you..."

:(Sorry this was so long--had to vent. And no, the secretaries are not allowed to do any computer order entry, and no one but the doctors can enter the diagnosis and condition of the patient. That slows order entry even more, because those entries generate the proper order sets that I have to search for separately.

Oh, well. I have two days to recover!

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Specializes in ER.
I've taken orders on "direct admits" plenty of times.

cheers,

direct admits through the ER? In my experience, if they're in the ER, there has to be something on them - they can't just sit in the ER w/o some order (admit to floor, floor to call for orders kind of thing). If no admit orders in a reasonable period of time, the ER doc will go in and start working them up. Liability reasons, I'm sure.

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Specializes in ER.
ED nurses take orders routinely on patients whom they know NOTHING about. But wherever I've worked, the bed people had to have a name, age, dx and type of bed required before issuing any assignment of which floor or bed.

We recently instituted CPOE (computerized physician order entry, for those unfamiliar--all docs put in their own orders) and I had my first verbal admit orders yesterday. I learned a couple of lessons. #1--It is best to refuse to take verbal orders if possible. (Not the few ED ones--I am talking the whole list of admission orders) It took me no less than 1-2 hours with direct hands-on assistance from computer personnel for me to enter the physician's orders correctly. #2--If I have to take the orders, I will sit at the computer, pull up the screen, and read every line to the physician for verification. (One episode of that should bring verbal orders to a screeching halt; my charge nurse was not happy that I was required to take the orders.):argue: The doc who handed me the phone apologized repeatedly; I think when the ED docs see what happens, they will deflect the verbal order requests. One can only pray.

I tried to do written ones on our old format like it used to be, and send it with the patient to the floor, but that requires the nurse on the floor to sit and go through what I was trying to avoid in the ED. So I got bit this time,:angryfire but next time it will be "aren't you able to enter these? You know I am required to put them directly into the computer, and if I don't I will have to call you repeatedly over the next 2 hours to clarify every pharmacy override, missing order, etc, etc...." "Yes, I really think you should either come in, do these at your office or get the hospitalist to admit for you..."

:(Sorry this was so long--had to vent. And no, the secretaries are not allowed to do any computer order entry, and no one but the doctors can enter the diagnosis and condition of the patient. That slows order entry even more, because those entries generate the proper order sets that I have to search for separately.

Oh, well. I have two days to recover!

CPOE, Computerized PHYSICIAN order entry! Why were you entering them? Are there hospitalists? There must be some way around that, like having that doc get his or her bum in there to enter them. That ties up a nurse, and esp. in the ER, who has time to sit for an extended period of time entering orders. Come on, now! Did CPOE just go live where you work? The ER doc do CPOE right? Is it just the admit portion that is still in limbo? That is a question and scenario that is definitely worthy of bringing up to your manager, director, education person... that is inappropriate for any nurse to do what a physician should be doing.

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