Verbal order

[bstern]

A nurse gives you a VO she has taken from a NP. You find out later that the NP was never actually called, and did not give the order. While the order content itself was not critical, and caused no harm, he did not give the order. What happens now? Should it be reported to the state ed dept, could she lose her job?

[traumaRUs, MSN, APRN]

That is falsification of documentation and practicing medicine w/o a license. I would not be so quick to report to the BON but I would definitely report it to the unit manager.

[bstern]

That is falsification of documentation and practicing medicine w/o a license. I would not be so quick to report to the BON but I would definitely report it to the unit manager.

It has been reported to our unit manager, and we are just waiting to see what she does with the information. She has asked for documentation from the NP, and from the co-signing nurse. I'm sure telephone records will be checked to verify. This is not a "new" nurse, but a seasoned professional, and she knows better. She is "new" to us, and is in an administrative position. The nurses on the unit are now leery of taking direction from her, myself included.

[traumaRUs, MSN, APRN]

I would be too. This is a very dangerous practice to engage in, if she did it. I hope the manager looks deeply into this issue.

[chuck1234]

He says and she says....

I don't know who is right and who is wrong...

Wow, if an intern told me to give methadone 10mg IM stat, and I gave it. Later on, I asked him to write the order and he/she said "I never ordered it!" I will be in big trouble..... Fortunately, in the city owed hospital, except in the case of code call, nurses are not allowed to take any verbal orders.

Just report it to the Nurse Manager is already good enough. Except that nurse stepped on you toes before, now you wanted to get even....getting her/him into a trouble.

[bstern]

He says and she says....

I don't know who is right and who is wrong...

Wow, if an intern told me to give methadone 10mg IM stat, and I gave it. Later on, I asked him to write the order and he/she said "I never ordered it!" I will be in big trouble..... Fortunately, in the city owed hospital, except in the case of code call, nurses are not allowed to take any verbal orders.

Just report it to the Nurse Manager is already good enough. Except that nurse stepped on you toes before, now you wanted to get even....getting her/him into a trouble.

I'm not really sure what you mean when you say she stepped on toes before, and now it's a matter of getting even. I really am not involved directly in this at all, except as one of the staff nurses in the facility. The NP and the co-signing nurse are the reporters of this incident. I don't feel their reporting it is getting her in trouble, her actions got her in trouble. She has no one to blame but herself for using very poor judgment. I just wanted an outside opinion on the matter.

[Tweety, BSN, RN]

It might come back to the person taking the order from a non-practioiner.

[rn/writer, RN]

If I'm understanding this correctly, Person A was told by Person B that Person C gave a verbal order for X. If I were Person A, I would go look at the chart regardless of who told me about the order just because I would want to verify with my own eyes that I had all the information. If I didn't find the order in the chart, I would ask Person B to write it before I did anything further. If she didn't want to, I would tell her to let me know when she had and I would gladly take if from there. Nothing would happen until I read a properly signed order. Nothing.

Technically, this would have been a telephone order. In our facility, and I believe in most these days, you are supposed to write TORB which stands for "Telephone order, read back." Verbal orders are frowned upon. If the doc is there with you face to face, he or she is expected to write that order in the chart with the exception of being summoned for a code or something equally dramatic. We are being discouraged from acting as docs' secretaries and this is a good thing.

With this in mind, if the nurse says she took a telephone order from an NP and she did no such thing, she's in serious do-do. The nurse who accepts her word and follows the "order" is in error for not actually looking at the chart. I know that seems like a picky thing to do, but it's a safety precaution designed to prevent precisely this kind of situation.

This isn't about "getting" anyone in trouble. It's about people taking shortcuts that bite them in the end. With the NP, it is a she said/she said situation and those are beastly to try to resolve. But for the nurse who passed on a verbal order and for the nurse who accepted this order without checking the chart, there isn't much to discuss. Mistakes were made.

Seems like the nurse who said she took the order has a double share of responsibility. She didn't write the order to cover her own anatomy, and she passed the order on to someone else. The nurse who accepted an unwritten order is responsible only for her own omission.

I hope that the facilty will use this as a learning opportunity and not as a chance to hang people out to dry. I don't know anyone who has never taken a shortcut, but hearing something like this renews my motivation to do things by the book.

[bstern]

If I'm understanding this correctly, Person A was told by Person B that Person C gave a verbal order for X. If I were Person A, I would go look at the chart regardless of who told me about the order just because I would want to verify with my own eyes that I had all the information. If I didn't find the order in the chart, I would ask Person B to write it before I did anything further. If she didn't want to, I would tell her to let me know when she had and I would gladly take if from there. Nothing would happen until I read a properly signed order. Nothing.

Technically, this would have been a telephone order. In our facility, and I believe in most these days, you are supposed to write TORB which stands for "Telephone order, read back." Verbal orders are frowned upon. If the doc is there with you face to face, he or she is expected to write that order in the chart with the exception of being summoned for a code or something equally dramatic. We are being discouraged from acting as docs' secretaries and this is a good thing.

With this in mind, if the nurse says she took a telephone order from an NP and she did no such thing, she's in serious do-do. The nurse who accepts her word and follows the "order" is in error for not actually looking at the chart. I know that seems like a picky thing to do, but it's a safety precaution designed to prevent precisely this kind of situation.

This isn't about "getting" anyone in trouble. It's about people taking shortcuts that bite them in the end. With the NP, it is a she said/she said situation and those are beastly to try to resolve. But for the nurse who passed on a verbal order and for the nurse who accepted this order without checking the chart, there isn't much to discuss. Mistakes were made.

Seems like the nurse who said she took the order has a double share of responsibility. She didn't write the order to cover her own anatomy, and she passed the order on to someone else. The nurse who accepted an unwritten order is responsible only for her own omission.

I hope that the facilty will use this as a learning opportunity and not as a chance to hang people out to dry. I don't know anyone who has never taken a shortcut, but hearing something like this renews my motivation to do things by the book.

This was a verbal/telephone order. The nurse who "took" the order did indeed write that it was a telephone order, read back and confirmed. It was documented as such in the chart. The nurse who implemented the order had no idea until the NP came in the next day that he was never called. To me, it was a deliberate misdeed. Perhaps where she worked before she had gotten away with things like that, but our NP was not having it, and rightfully so. She not only lied about it, she wrote a statement denying it and signed it. Seems to me that she should be terminated at the very least.

[rn/writer, RN]

This was a verbal/telephone order. The nurse who "took" the order did indeed write that it was a telephone order, read back and confirmed. It was documented as such in the chart. The nurse who implemented the order had no idea until the NP came in the next day that he was never called. To me, it was a deliberate misdeed. Perhaps where she worked before she had gotten away with things like that, but our NP was not having it, and rightfully so. She not only lied about it, she wrote a statement denying it and signed it. Seems to me that she should be terminated at the very least.

Not to nitpick, but it is either a verbal order (which is given face to face) or a telephone order. It can't be both.

And this sounds like it was neither.

If the nurse who wrote the phantom order did so on her own without ever really speaking to the NP, she is in big trouble. I don't blame the NP one bit for refusing to cover for her. Allowing such behavior opens the door to all kinds of fudging and that is not to be encouraged.

With the clarification, the nurse who followed the order written in the chart should be off the hook. If we can't trust our co-workers to be honest in writing orders, something is seriously wrong. No one should be expected to go behind other people's backs to double check if an order really was made. The very idea of that is absurd.

No, the nurse who wrote the bogus order should be left holding the whole bag. As for what constitutes fair discipline, that's a long and interesting discussion. But she is the only one in the equation who knowingly did something wrong.

[bstern]

Not to nitpick, but it is either a verbal order (which is given face to face) or a telephone order. It can't be both.

And this sounds like it was neither.

If the nurse who wrote the phantom order did so on her own without ever really speaking to the NP, she is in big trouble. I don't blame the NP one bit for refusing to cover for her. Allowing such behavior opens the door to all kinds of fudging and that is not to be encouraged.

With the clarification, the nurse who followed the order written in the chart should be off the hook. If we can't trust our co-workers to be honest in writing orders, something is seriously wrong. No one should be expected to go behind other people's backs to double check if an order really was made. The very idea of that is absurd.

No, the nurse who wrote the bogus order should be left holding the whole bag. As for what constitutes fair discipline, that's a long and interesting discussion. But she is the only one in the equation who knowingly did something wrong.

The nurse who wrote the order wrote "verbal/telephone order" in the chart. Sorry for any misunderstanding about that.

I guess what I'm really questioning is, why would she such a thing in the first place?

[rn/writer, RN]

The nurse who wrote the order wrote "verbal/telephone order" in the chart. Sorry for any misunderstanding about that.

I guess what I'm really questioning is, why would she such a thing in the first place?

I'm rolling my eyes over the actual writing of "verbal/telephone order" in the chart. What--this is to cover either eventuality when she finally does get the dadgum order? That's sad and sorry.

As to why someone would do such a thing, my first guess is a bit of overconfidence. Many of us get to the point where we have a pretty good idea who will prescribe what. That's not a problem. But writing anticipatory orders is. There's a fine line between knowing what a doc is likely to want and ordering it yourself. She crossed that line. With both feet.