Verbal orders vs Telephone orders

[fultzymom]

I'm assuming that by 'order' do you medication prescription?

Here in the UK, if it ain't written down it ain't legal.

While, yes there are certain situations that I will accept an 'order' over the phone it would be on me legally all the way no matter who else hear wittnessed it.

In view of that I always taught my students never to take a verbal/ telephone order.

Greyer area as regards care directions, eg; D/C a cath or I can't think of anything else right now yes we would take verbals, though a lot of the time I have to admit I would tell the doc what we intended to do and they would go along with it.

If you do not take TO's how do you contact doc when he is not in the facility to address something? Surely the pt does not have to wait until the doc gets there for something that is needed now?! We do TO's all the time here. Also, as far as I know we are allowed to do a VO. If I ask doc for something when I am speaking with him et he says ok then I just go write up the order on a TO slip. That has always been our policy.

[kittagirl]

fultzymom:

As I said above in an acute site we have a doc on site 24/7 in the community ie: nursing homes etc, the GP are required by law to provide a 24hr call out service, they can either do so themselves or employ a locum agency to do so.

As an aside even if a order was made over the 'phone nursing homes over here do not have a pharmacy and would not have access to any new medication orders.

This is really educational,

Ladybugleaqueen: LTC= is that Long term care? Are your patients are rehab or are they chronically ill?

[TazziRN, RN]

Long term care is another term for nursing homes.

[Ladybugleaqueen]

fultzymom:

As I said above in an acute site we have a doc on site 24/7 in the community ie: nursing homes etc, the GP are required by law to provide a 24hr call out service, they can either do so themselves or employ a locum agency to do so.

As an aside even if a order was made over the 'phone nursing homes over here do not have a pharmacy and would not have access to any new medication orders.

This is really educational,

Ladybugleaqueen: LTC= is that Long term care? Are your patients are rehab or are they chronically ill?

We have a combination of all rehab, chronically ill, and long term residents. Most nursing homes have a pharmacy they deal with to deliver their meds the pharmacy we use is a couple of hours away 24 hour service.

[TrudyRN]

Maybe this is a situation where the difference between the UK and the US can be seen. (I'll admit that I'm assuming that you're US based)

'What if the doc is not present but you need an urgent order, such as pain or fever Rx or even a laxative or something for sleep or itching?'

On an acute site you get the on-call doc to prescribe it. There is a medical doc on call 24hr on site to deal with situations such as this. In nursing homes etc, most in my area are trying to bring in 'care bundles' otherwise they would call the patients GP on call who are obliged to either visit or refer on usually to A/E (ER). Neither the nurse nor doctor would have any protection as regards a verbal order in this area

Or what if the patient needs an ice pack or heating pad for comfort?

Why would I need Dr to prescribe that? That would be a nursing decision.

AS for a transfer from a nursing home to an ER, again that would be a nursing decision.

But I do feel I really have to comment on your 'hope for the best', how can that be considered best practice? If the doctor is being paid to give his/ her opinion make a decision why aren't they there?

AS for doctors secretaries I never have and never will do a doctor's documentation for them. Not my job. Nor do we have unit secretaries, the most we have is a clerk that would only work office hours and is there to stock/ order nursing stationery, answer phones, make out-patient appointments and file nursing documents.

It is drummed in to us from the day we start nursing school that if it is not written down it is legal/ never happened. It is drummed in to us again by our unions that they can not and will not protect us, if we give a medication that was not prescribed.

I have witnessed a nurse lose their licence over this, yes they were possibly doing what was best for that patient, yes it was witnessed by another nurse, and yes the doc did come up to the ward the following day to prescribe the med, however in the mean time there had been an audit of the patient notes, this was picked up and as I said the nurse lost their job and licence.

This was a experienced nurse, no harm came to the patient, every one had the best intentions, but they did something illegal. That was the stand of the hospital and their union.

So for the convenience of one doctor, thousands of pounds in training cost lost and the a good nurse gone

The heat and ice, transfer from LTC to ER unless absolutely dire emergency, even a bandaid, for God's sake - all are by MD order where I work in America. Maybe different in UK. Not all hospitals here have on-call docs in-house, certainly nursing homes neve do. Even in hospitals that have on-calls docs in-house, they are not likely to come see the patient unless it is a serious situation. They just give phone orders.

[TrudyRN]

fultzymom:

As I said above in an acute site we have a doc on site 24/7 in the community ie: nursing homes etc, the GP are required by law to provide a 24hr call out service, they can either do so themselves or employ a locum agency to do so.

As an aside even if a order was made over the 'phone nursing homes over here do not have a pharmacy and would not have access to any new medication orders.

This is really educational,

Ladybugleaqueen: LTC= is that Long term care? Are your patients are rehab or are they chronically ill?

Do you have a stat box in which you keep a few doses of things you might need quickly? Like potassium, benadryl, antibiotics, narcan, things like this?

[kittagirl]

'Do you have a stat box in which you keep a few doses of things you might need quickly? Like potassium, benadryl, antibiotics, narcan, things like this?'

In nursing homes, No they don't.

In a case where a patient/ client went off in a nursing home it's off to A/E (ER) they go most nursing home only have a GP round 2 a week

[cardiacRN2006, ADN, RN]

It is drummed in to us from the day we start nursing school that if it is not written down it is legal/ never happened.

It IS written down, in the chart, by me.

We take both VO and TO, and I always write RB (read back) in the little box.

I make sure to get the Drs to sign all orders whenever I see them next...

[HappyNurse2005, RN]

we just have "verbal order" and have to signify read back. i think this is a jcaho thing, yes?

something like

admit to labor and delivery. routine labor orders

VO Dr. XXXX/RB Happy Nurse, RN

(with date and time of course)

then, they get a little green sticker underneath for them to sign/date at a later time, acknowledging that they did actually give the verbal order. this isn't a new sticker thing, but for a while we were diong the verbal order without the confirmation sticker, so they havne't always been hand in hand.

verbal orders and telephone orders handled the same.

[Rnandsoccermom]

The hospital I work at is 100% computerized, no paper. We have been doing this as well, difficult to ascertain verbal vs. T.O. since all SPOKEN orders are verbal orders. We have a prompt on the screen that the order was read back to the MD, and a prompt to differentiate verbal or T.O. I always put verbal, that's what it was, a spoken order.

[clee1]

I probably take 1-2 dozen TO/VO's a night.

TO/VO Dr. XXXXXX

Medication 2mg IV q4h prn pain

RBAC/Dr. XXXXXX/Me, LPN

Have had zero problems as yet, and only once have I asked the charge to verify the order (a cardizem IVP order).

[allantiques4me]

We were taught to do that in nursing school.Some places try to have you deviate from safe practice.Always remember what you learned in school and safety first.