Verbal orders for narcotics

[Geslina, BSN, RN]

The day shift nurse, who had left for the day, called the patient's MD from home and got verbal orders for PRN narcotics for a patient on a sub acute floor. I'm supposing she didn't have time to do this during her shift. This nurse then calls the nursing supervisor and gives her the orders. The supervisor writes them down, and passes them on to the 2nd shift floor nurse who has that patient with the request to write the orders. The orders were for four narcotics, including OxyContin.

What would you do? It's not possible at this point to reach the doctor personally.

[Rocknurse, MSN, APRN, NP]

It depends what schedule the drug is classed in.

If it's a schedule II, it must be hand-written or typed (unless e-prescribed)

A controlled (III-V) Rx can be issued verbally (via phone call)

Can a CII Rx ever be phoned into a pharmacy? Yes. But only in an emergency when it is not possible to give the patient a hard copy AND another medication cannot be substituted

This is the Pharmacy Law I was taught in my NP program

However, it seems like a game of Chinese Whispers, and is sketchy. Too many intermediaries

[psu_213, BSN, RN]

The day shift nurse, who had left for the day, called the patient's MD from home and got verbal orders for PRN narcotics for a patient on a sub acute floor. I'm supposing she didn't have time to do this during her shift. This nurse then calls the nursing supervisor and gives her the orders. The supervisor writes them down, and passes them on to the 2nd shift floor nurse who has that patient with the request to write the orders. The orders were for four narcotics, including OxyContin.

What would you do? It's not possible at this point to reach the doctor personally.

Write out "VO per nursing supervisor per 1st shift nurse per Dr. Smith."

Someone has to be on call for this doctor. I'm not administering anything in this order until I speak with the physician (or a nurse who did speak with him/her enters the order).

[klone, MSN, RN]

Oh hell no.

IF a verbal order is legit (which, it really isn't except in code/emergent situations, but that's an argument for another day) then it needs to be FROM the physician, TO the RN who is putting it into the computer, and the RN needs to repeat back. You can't play telephone and hand off an order amongst multiple people. That's how med errors occur.

In a situation described in the OP, I would probably do a verbal corrective action with the nurse.

What she SHOULD have done is called the unit, spoke to the patient's nurse, let her know that she forgot to enter in orders for the patient, and then the current nurse should call the provider (or A provider, because there must be someone available) to get the orders, which she can then put into the computer. Or, the original nurse can change out of her jammies, drive back to the hospital, and put the orders into the computer that she forgot to do during her shift.

[Nurse SMS, MSN, RN]

Nope. I would call the physician myself to clarify the order.

[JKL33]

What would you do? It's not possible at this point to reach the doctor personally.

There has to be a way to contact the service responsible for the patient's medical care. If there isn't, that's another problem just as big as (or bigger than) the first.

Heck no I would not administer narcotics from a third-hand order. This is a ridiculous situation that bears further investigation. Both the day shift nurse and the supervisor acted in an obviously wrong manner. Officially not "prudent." I'm guessing the day shift nurse's actions, in particular, are the result of some hinky circumstances beyond poor judgment....whatever those may be....

I would utilize the organization's incident reporting system, and would continue to try to reach the on-call service, documenting each attempt in the chart. If I didn't have any trustworthy resources immediately at hand to advise me how to handle this legally, I'm guessing I would also probably bury a note somewhere in the chart that "Orders for ______ medications are being held at this time, or until further verification." Because I also don't need anyone wondering why I didn't use them to treat the patient's pain.

[Nurse SMS, MSN, RN]

If there is no way to reach the physician and that nurse is the one who spoke to him or her, then that nurse has to be the one to enter in the order, period. There is NO GRAY AREA regarding this in terms of the law. The nurse needs to come in and enter it.

[MunoRN, RN]

After being passed along that many times, I might prefer to confirm the order, dosages, frequency etc with the MD directly. If it's true that there is no MD to contact then I would report them to their licensing board and HHS as a possible violation.

[FolksBtrippin, BSN, RN]

As others have stated, I would call the doc and get the orders myself or not give the meds.

I would probably skip an incident report though.

And I wouldn't document that something hadn't been documented by another nurse.

The way I see it, you don't have an order. You can get the order yourself if it is appropriate. Or not give the med and not get the order if it is not appropriate.

No other viable options in my book.

[Crush]

Hell no. I would either call doctor myself or have the original nurse who spoke put in the order but heck no. There has to be someone on-call.

[BostonFNP, APRN]

In order for a CSII to be given as a verbal order the ordering provider would need to consider the situation emergent (and acute pain could be considered that). If it wasn't an emergent issue, than that is the responsibility of the provider.

But did I read this correctly that the 1st shift RN called the patient's provider from her home after her shift? Got the order then called the supervisor to relay it? There are two big concerns here: how much time has passed since the 1st shift RN noted the patient in (presuming) emergent pain and the fact it has been through two intermediaries.

This is a tough situation. The patient is (presumed) in acute pain and not being treated. Many on-calls can't or won't prescribe pain medication. This leave a choice between the patient remaining in pain or being treated in the ED. I would be pretty ticked as a provider if it were my patient.

After being passed along that many times, I might prefer to confirm the order, dosages, frequency etc with the MD directly. If it's true that there is no MD to contact then I would report them to their licensing board and HHS as a possible violation.

You would consider reporting the doctor for this? I don't follow that logic.

[Horseshoe, BSN, RN]

Is this a homework question?