Verbal Orders

[D. Rowe]

In our ER the RN's take verbal admission orders from the attending (admitting) physician. This has become very time consuming because MANY orders are given versus just immediate orders. Our medical staff sees nothing wrong with this but it is taking us away from patient care. How do other ERs handle admission orders?

[CEN35]

Re: Admission orders

In our ER we take T.O. admission orders.......... allegedly as a courtesy, so that the attendings don't have to come in, or get a second phone call an hour later when the pt arrives to the floor.

Most of the nurses in the ER don't mind this, but we all agree that when we are geting crushed, it is not appropriate. However, the way our hospital is run, it is generally expected of us to take all admitiing orders.

The other problem that we run into with this procedure, is with the floors. The floor will sometimes ask us to read the orders to them in phone report. If they think something is inappropriate, they will refuse to take the pt, until we contact the attending to clarify, and/or change the orders to the floors appeal. This slows down the time of pt stay, in the ED immensly at times.

On the bright side, we move people faster than just about any other ER in our area. Yes, even with the number of full work ups and other things going on.

The other problem is that, our attendings expect a nurse to be waiting at the phone, just to take orders as soon as the ER doc is done talking to them. If were not, they hang up. They have a hard time realizing that our job is not to wait hand on foot for them to give orders. So I clearly understand your situation.

I don't have the answer for you. It is going to use some of your staffs time up, regardless.

Rick

[CHUBBY]

The only verbal orders we take are from ER docs for ER patients. All admitted pts. are seen by the resident, a RAN is done and away they go!. The other hospital I worked at, the pt. went up, the house intern saw the pt and did the orders. In the event of monitored type-pts., we have a CCU protocol sheet that the ER doc can sign for basic orders. Then the nurse getting the pt. on the floor gets verbals from the attending.

[CEN35]

Chubby - That's fine and dandy if you have residents available to do that. WE don't have residents. OUr hospital is not a teaching hosppital. The ER docs belong to a board certified Emergency Medicine group that staffs many ER's in the area. They do not have admitting privledges, and are not employees of the hospital, anf therefore cannot write in house orders.

CEN

[k.Sheldon]

In our ED the only verbal orders that the staff takes are from our ED physicians. The admitting RN on the floors will call for admitting orders from the attendings.

[k.Sheldon]

In our ED the only verbal orders that the staff takes are from our ED physicians. The admitting RN on the floors will call for admitting orders from the attendings.

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Kate

[sheez]

I'm sorta late to this discussion, but don't most docs own a fax machine?

Why can't they fax the written orders directly to the ER or better yet the floor admitting the patient? I have a hard time understanding some of the accents and this would reduce the confusion. Of course, if you can't read the handwriting, then the admitting nurse can call the doc back.

Just an idea.

Sheez

[terilyn]

I don't work in the ER, I work on med/surg and we always take verbal orders, well mostly they are telephone orders. Especially because we are not a teaching hospital, and we deal with only attendings. When we get the patients from the ER, sometimes the ER physicians write the admitting orders until we can get in touch with the attendings. But, 9 times out of 10, the admitting orders are telephone orders from the admitting that the ER nurse took.

[TraumaNurse30]

I don't know about other hospitals in the country, but I our ED we are consistantly holdin admitted pts in the ED because the hospital is full. However time consuming it may be, I have the chance to have the MD on the phone while going over orders. That way if he has omitted anything, I don't have to waste time later calling him back.

Also, the problem I see with faxing orders is that our hospital requires that you copy all faxed orders on a hospital order sheet for the MD to sign later. So, no time is saved by faxing them.

[Roach]

Most floor nurses are glad to call an MD when there is a "call MD on arrival" order written in the ER. I just think again it is more of a convenience for the MD to give all the orders right away and hoping they won't be bothered again by the floor. Usually, there is some inevitable reason they are called again once the patient reaches the floor. It is just to bad that the MD's don't realize this. Preprinted standing orders are also a time saver. These are on our floors, done by MD's who admit often. Maybe us Nurses need to suggest this for more MD's. Just put the idea into their heads. You never know, it might work.

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Roach

[ratchetrn]

We take telephone orders ALL the time! Not a huge issue, it's way worse when we have to hold the pt for an hour waiting for the admitting. then it takes that Doc a hour or more to see the patient and write orders!UGH! Then the whole time the patient and their family think it's th ED's fault it takes so long to get upstairs! :selfbonk:

Sometimes Our ER Docs write brief "telephone orders" from the admitting "per Dr. SonSo" :yelclap:

We also have to do the whole "read back" thing...some of the Dr's aren't so happy about that and will refuse to have orders read back and have hung up on a couple of us! That's just rude!

[mom23RN]

Our docs always did it themselves. We certainly never had time to sit down and write up a page full of orders. They were the ones that talked to the admitting doc they were the ones to write up the orders.