Verbal orders for narcotics

[Geslina]

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.

[ruby_jane, BSN, RN]

Is this a homework question?

^I thought this, too!!^

Nurse 1 made an error and attempted to cover up the mistake by retroactively getting orders. But I agree with the previous poster that, in this scenario, she should have come back to write her own dadgum VO in the chart (thereby acknowledging her error)....

[beekee]

No way would I (a) have the MD's phone number at home or (b) get a verbal order for a narcotic while at home. That makes no sense. Why not pass on to the next nurse that the patient needs pain meds?

[Meriwhen, ASN, BSN, MSN, RN]

IMO, this is a game of Telephone. And we all know what happens in a game of Telephone: what's said at the start of the game isn't usually what the last person says at the end.

You don't want to play loose with controlled substances, and neither would a wise MD. I would either have the nurse who took the original verbal orders from the prescriber enter it in, or call the prescriber/on-call MD to request verification before entering them in.

[saongiri]

How was the nurse at home able to get in touch with the doctor? That makes no sense to me. If she can get in touch with him then a staff nurse should be able to. And I also don't understand a nursing supervisor taking third hand orders then giving them to a floor nurse. I hope this is a fictional scenario for cripes sake.

[Emergent, RN]

If the patient is still in pain, call the current on call doctor and get a new order.

[FolksBtrippin, BSN, RN]

✋...Did the first nurse give the narcotic already?

It sucks to be her. I would not be touching that with a 10 foot pole. She needs to get back there and put the order in. Not doing it for her even if my sup asked me to.

[brillohead, ADN, RN]

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

Reporting the doctor was only in the event that there truly is nobody able to cover that doctor's service (to be able to verify or replace the order given) -- not reporting the doctor for having given the order in the first place.

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.

[KarenMS]

Lol no. I'm not sure how this is even a question. There IS a doctor who can be reached.

[LovingLife123]

This has to be a homework question. No way is there not a way to get a hold of a physician. Somebody has to be on call. I also do not know of any RN who has doctors numbers at home. A nurse can call this doctor from home, but nobody in the facility can?

A very badly worded homework question.

[kbrn2002, ADN, RN]

OK, first off that's just bonkers. Why would any nurse call an MD from home to request narcotics for a patient in the first place? Why would a supervisor accept a second hand verbal order from a nurse that called from home after a shift and then pass along a now third hand verbal order to yet another nurse to process it? Not exactly the way things are normally done to say the least.

In any case, no matter how convoluted the process for getting the order was if there are not actually prescriptions in hand for said narcotics nothing to be done but reach the MD that wrote the initial orders, or reach an on call and hope for one that will provide the necessary prescriptions. Without a written prescription you can process orders all day but the pharmacy won't dispense them.

Hopefully this wacky situation is already resolved but for future reference the easiest way to confirm any orders that may have been written is to contact your pharmacy and ask them for a copy of the prescription then process the order as written by the MD to the pharmacy. The verbal orders themselves don't mean squat without that written Rx anyway, no pharmacy is going to dispense the meds without that prescription.

[klone, MSN, RN]

This has to be a homework question. No way is there not a way to get a hold of a physician. Somebody has to be on call. I also do not know of any RN who has doctors numbers at home. A nurse can call this doctor from home, but nobody in the facility can?

A very badly worded homework question.

You have clearly never worked in a small town hospital.

[psu_213, BSN, RN]

Without a written prescription you can process orders all day but the pharmacy won't dispense them.

If this was an outpatient prescription, yes. However, not the case in the hospital. I never did like taking an phone order for opioids, but, especially at a community hospital, it was a necessity. I never really had an issue getting ahold of a doctor, but if that was "private" physician, he is not going to drop everything while out to dinner to find a computer to put in an order for meds. Doctors aren't going to get out of bed during the middle of the night to enter an order. To everyone who says that they will "never" put in a phone order for pain meds--in theory that sounds really good. If it is 6 pm, I'm not going to let my patient sit in pain for 14 hours until the MD rounds the next morning. Stand up to the doc and say "no, policy is for you to put them in?" On principle that may be right, but, especially in smaller hospitals, my experience is that every dispute is decided in favor of the doctor.