Verbal order mistake

[Nurse4lifewithparrots]

I came on here to ask a tele question, but I thought I would share this also since it was a mistake I made and maybe someone can learn from it? (and so I can talk about it)

A bit ago I had a patient who the cardiologist ordered to be on a heparin gtt. The cardiologist who ordered it said that the patient should have been on the drip 2 days ago, and to just get the patient on it and "don't worry about the bolus protocols or titrating". The cardiologist also wrote in a note regarding no bolus and titration. He put the hep gtt order in, but the protocol was still there for the bolus and titrating. I called him and he said he didn't know how to take the protocol out.

My first mistake was not asking him to put a nursing order in to explain that. My second mistake was not calling pharmacy right away and asking if there was a way to take the protocol out. I waited a whole day before I did that. My third mistake was not charting about the PTT. It happened to come back as therapeutic 2 times, so then, by protocol, a PTT wouldn't need to be drawn again for 24 hrs.  But I didn't chart I was acknowledging the PTT in the MAR when I did the heparin gtt. My fourth mistake was, at the end of the day I called the cardiologist because I got worried I did this wrong, and I told him I was concerned about safety. Cardiologist immediately said that he never said the verbal order and I should have been titrating. (Which didn't matter because PTT was therapeutic and no titration needed though). I just was worrying about the protocol BEING there and me going off the shift and passing this on that wasn't clear and a verbal order.

Good lesson to me. I'm never taking a verbal order again unless it's in a code or rapid. Does anyone here take verbal orders outside of emergencies?

[barcode120x, RN, NP]

Taking verbal orders was (and still is) pretty frequent on my floor at the time. We were told many times during initial training/orientation not to take verbal orders, but in the end, I'd say most of us take it. At the end of the day, it comes down to what your facility policies are regarding verbal orders and then also how comfortable you are in taking them. As you probably noticed by now, sometimes docs do their specific orders slightly different than the typical policy. Best thing you can do is clarify the order and double check with senior nurses if you are also unsure. And remember, always chart what happened. I always charted an SBAR note regarding receiving that order. If you are reviewing doctor's notes and/or progress notes, remember, those are not actual orders.

A good way of getting around taking a verbal order is to say, "are you going to put that order in?" 9.9 times out of 10 they will say yes. In the end, all doctors should always be putting their own orders in, but we don't live in that nice world.

[LovingLife123]

So, the cardiologist put a protocol in and just wanted the heparin to run at a set rate?  Why didn't you just call pharmacy so they could call the cardiologist and confirm the rate?

I really don't think this is about a verbal order.  This is about a medication not being ordered properly.  The heparin protocols are a huge pain to put in if the doc doesn't exactly want the protocol.  I'd always get pharmacy involved.  
 

Pharmacists are truly a nurses best friend.  Learn from this mistake and get everything ironed out with the orders before starting gtts.