Verbal orders...what about them?

I define a verbal order as an order that the doctor gives the nurse verbally while in the same room. In other words, it is at the nurse's station or in the pt room, and you are saving the doctor the trouble of immediately writing down the order. You can go give that IV Lasix and order that ABG before you even write it down.

A telephone order would be an order given over the telephone.

Thanks for the correction...so, for the above scenario, would the diet order change be a telephone order, is it okay for the scretary to take that, should I lighten up, ect?

Sometimes, with uncomplicated orders such as a diet change, in the interest of expediency I have allowed the unit secretary to get the OK. Technically you are supposed to speak directly, but for a simple diet order I would trust the unit secretary.

Sometimes, with uncomplicated orders such as a diet change, in the interest of expediency I have allowed the unit secretary to get the OK. Technically you are supposed to speak directly, but for a simple diet order I would trust the unit secretary.

Ditto this. I've had the secretary take an order that wasn't really appropriate- it was for lab draws...and she even agreed with me. The dr didn't want to wait for her to find me. I called him back anyway.

Orders can only be taken from the physician by those licensed to be allowed to take them; i.e. RNs (in acute care), but not secretaries or other UAPs.

While it is well understood that physicians are busy and may not want to wait for a person allowed by law to take the order to make it to the phone, they still need to wait, or call back, or be called back.

Even orders such as diet changes and labs need to be recorded into the chart under the order section- by either the physician themselves or the nurse who took the verbal or telephone order.

Nurses who allow this practice to go on-even in the interest of time or for small matters- are exhibiting bad practice. If the physician tries to hurriedly give orders to someone not legally allowed the take them, I call them back and say, Dr. so and so, you just spoke with this person regarding orders for....; I'm sorry, but they are unable to take physician orders. Would you like to give the orders to me, I am the RN caring for this patient...

After being called back a couple times, the docs generally find it is more of a bother to be paged and called back than intially waiting those few moments for a nurse : )

Cardiac-RN, BSN, PCCN

I would not take any order through a unit secretary be it diet, change in VS, a simple order for tylenol, whatever. The order needs to be verbalized, repeated and confirmed between two licensed persons. That includes no medical assistants. Only those with a license.

Thanks for the correction...so, for the above scenario, would the diet order change be a telephone order, is it okay for the scretary to take that, should I lighten up, ect?

No, it is not okay for the secretary to take a telephone order.

I agree with everyone else. No matter how "small" or "insignificant" the order is, it should always taken by the RN (in my state, LPN's are not allowed to take verbal/telephone orders). I am a nurse apprentice, thus I do not take verbal orders either.

The unit secretary on my floor knows not to take any type of order from a physician. She understands that she could potentially get in just as much trouble as the RN who takes an order from a unit secretary.

And regardless of how insignificant the order seems, there is always room for error. I actually have an example of this going wrong. I work graveyard shifts and our blood draws are drawn at 2:00 a.m. from the laboratory staff. Well around 6:00 a.m. the pediatric resident physician pulled up lab results for his patients and he came upto me and my preceptor nurse and inquired as to why blood was not drawn on patient X. I got the chart and made sure the order was signed, noted, scanned, and noted as inputted. Everything was completed on it and we were baffled. We called the lab to ask if they drew blood on patient X and they said they never received a computer order to draw blood on this patient.

The resident was pretty angry and blamed the lab because it was noted on the patients chart that it was inputted into the computer. Well, the unit secretary came in 30 minutes later -- she is the one who inputs all of the orders on the computer during the day -- and she said she had inputted what the doctor had said.

Come to find out later, this was a verbal order. What had happened is the resident had verbalized to the nurse at the nursing station as he was leaving to draw certain labs for patient X in a certain room #. The secretary overheard the VO for the certain number and put in for the lab draws on the computer. As the nurse brought the chart over to the secretary to enter the order, the secretary responded with "I put it in... I heard him verbalize the order to him". The nurse signed the chart as the order being inputted into the computer and went on her way.

Well, come to find out the doctor verbalized the right patients name but the wrong room number. The secretary only heard the verbalization of the room #.

Obviously this is different then what the OP was referring to, but it shows how the most "insignificant" and simplest orders can be misconstrued and why the ultimate responsibility should fall on the RN. In this case, nothing obviously happened and they ordered a new blood draw for the right patient. However, there was an unnecessary blood draw to one of the other patients (in this case, it was an infant).

sistermike,

That's entirely different than a simple verification of a diet order.

Sometimes, when we call during the day, we leave a message with the office nurse with our request. For instance, I'll call for a diet upgrade, leave a message, and get a call back with an answer, which is sometimes through the office nurse.

For a simple diet change request, I'll trust the unit secretary if I am truly indisposed. I will bend the rules at times, using my nursing judgement if it is as straightforward as a diet order. For certain labs at specific times, you need to check to see if they are entered correctly, whether it's a written or verbal order. But a simple diet order right before lunch, sometimes it's in the best interest of the patient to expediate their needs being met by trusting another member of the healthcare team.

I would never accept a verbal or telephone order given to anyone other a nurse. And if another nurse besides myself took the order I would even ask that nurse to write the order.

I thought verbal orders were a no-no with Jcaho now anyway? We are only allowed to take 'Read back telephone orders'; no verbal orders allowed. It it different elsewhere?