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Discussion

Telephone order errors

I believe I recently had an error in taking a telephone order. Our facility has gone to mostly cpoe but not all of the physicians are able to enter their own orders yet. So the other day, I floated to the er which is not my normal work area and I was told to call the psychiatrist on call to get admission orders for a psych pt. so the doctor (who has a very thick accent) was rattling off all of these Meds and then he said "restoril 50 mg po" which I wrote. I even did read back verification per policy. But then today I had to take orders from the same physician and he orders "vistaril 50 mg po" and this time spelled the medication, so I am clued into the fact that it must have been brought to his attention. I have read about these medications since and realized that 50 mg would be way high for restoril, but how do you prevent something like this from happening? I'm sure the pharmacy caught it when they were entering the orders and called for Clarification, so it is unlikely that the pt received the wrong medication, but I am still pretty upset by it.

Anyone have any similar problems?

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    What is your facility's policy for telephone orders? When I worked in the hospital, telephone orders had to be verified by two nurses.

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    We don't have that policy but that is a good idea. We just have to read back the orders and then the physician has to sign off on them within 24 hours.

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    Having 2 nurses verify phone orders couldn't hurt, but in situations like this you very well may just have 2 Nurses who hear "restoril".

    My facility banned trade names a few years ago and that's helped immensely. Restoril and Vistaril sound very similar. Hydroxyzine and Temazepam don't. That's the problem with trade names, they are specifically chosen because they sound pleasant, easy to remember, catchy, and positive. This limits the combination of sounds that can be used significantly, which is why so many trade names are easily confused.

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    If you are receiving a phone order that sounds so off, clarify again. Say "are you sure you want the patient to have 50 mg of xmed?" most docs with foreign accents I encounter understand we have difficulty sometimes. I am also not afraid to ask them to slow down a bit so I can understand them better. They may get frustrated, but my patient will be safer.

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

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