Telephone orders now our responsibility?

[kat29]

So the hospital I work has had JCAHO come down on us for having unsigned telephone orders. We've struggled with docs over this for awhile now. We remind them, we put colored flags on the each unsigned order with the docs name on it. The doc himself doesn't even have to sign...any partner within their group that rounds on the patient can sign for them, yet nursing is now being held responsible!

Here's the newest.... EVERY telephone order has to be faxed to the physicians office immediately (very time consuming). Then the doctor can sign and fax back. The result is duplicate photo copies all over the chart, especially if more than one doc has a telephone order on the same page. Here's the worst. If the order isn't signed in 48 hours, administration is holding THE NURSE THAT TOOK THE ORDER responsible. So if I take an order, fax the order, have two days off and the doc still hasnt signed then its MY responsibililty? Does this seem a bit rediculous to anyone here? What would you all do?

[LHH1996]

That does seem a bit rediculous to put the blame on the nurse who wrote the telephone order. nursing is 24/7 we all should help out. Not sure how your hospital is set up, but where is your nurse manager or DON? if they see an order hasn't been signed in a day they should help assist the nurses in getting it done. The doctor who is uncooperative would then be subject to a discussion with administration...

However these days with JCAHO or state surveyors, it seems everything falls on nursing regardless.

All you can do is the best you can!

Good Luck!

[Whispera, MSN, RN]

Where I've worked it was totally the doctor's responsibility to sign the orders he gave by phone. If he didn't, after enough of them, he lost privileges to admit patients to the hospital. I saw it happen to a few doctors a few times. It got them to catch up on things...

[nicurn001]

Admin is taking the easy option , blame the nurse , rather than correct the doctors behavior . The nurse ONLY provides care , the doctor brings business to the hospital , so admin can't / will not make doctors responsible for the losses non signed orders cause .

Simple answer would be to withdraw admitting priveledges or bill doctors for all unreimbursed fees due to non signed orders , if you hurt them in their pocket book maybe they would change their behaviour .

[diane227, LPN, RN]

That is soooo stupid. This is because someone at the top does not want to take the appropriate steps to make the doctors do what they area supposed to do. I would not worry about it. If they did not sign it and your manager rags on you about it, just tell her/him that you are not there 24 hours a day and cannot be responsible for what happens when you are not there. If she/he writes you up, file a grievance. This is absolutely a stupid rule. Every doctor in this country is trained to co-sign their verbal/telephone orders the next day. I just ignore stupid stuff like this. Also, the JCAHO standards themselves may assist you. You can contact them. I believe you can find their entire set of standards on line. And believe me, they do not say "nurses have to be responsible for having the doctor sign off their orders". All it will say is they have to sign off the orders and the hospital is then told to establish a plan to make this happen. And as always, lets put the job on the NURSE who just really has a lot of time to tend to this problem.