Verifying medications

[loveishope]

I work at a hospital where you enter all medication orders in the computer. After you enter the order in the computer, you have to verify the medication before it will appear on the emar. A nurse entered an order but failed to verify the medication. The night nurse did not give the medication because it was not on the emar. When she did her chart checks she found the order and noticed it had not been verified. She did not verify the order because she was uncomfortable about verifying a medication she did take an order for. She was told by her manager that she should have verified the order because " when you verify an order you are just verifying that you saw the order." actually, this response was written in a letter to her. Tell me if I'm mistaken, but when you verify a medication, you are in fact verifying that it is the right drug, right order, right dose, right patient, right route, and right time. You are doing a little more than just verifying you saw it.

[MunoRN, RN]

It depends on the system. When using CPOE, the system that I use has a screen with new CPOE orders which is just an FYI since there's nothing to "check-off" with CPOE. Once we've seen the order, we click it off and in that case you are just saying you saw the order.

I'm not sure I understand how your system works. Does a Nurse take an order such as a verbal or telephone order and then enter into the computer without writing it down?

Our system does not allow you to give a drug that that has not been reviewed either, but it does still come up in the EMR so that you know there is a drug due but it needs to be reviewed. The system you describe sounds problematic.

[loveishope]

Yes, the nurse just enters the order from a verbal or telephone order. Nothing is written down.

[MunoRN, RN]

So what is the Nurse who took the order checking it against, other than their memory?

[loveishope]

That's correct. The nurse has nothing to check the order against. So our manager wrote her up for not verifying a med that the other shift took an order for. She told her she should have verified it. We have no doctors in our hospital at night, just an NP or PA.

Putting the orders in the CPOE has fallen on the nurse. I feel

uncomfortable verifying an order that I did not personally take.

[Esme12, ASN, BSN, RN]

In the old days before computers we verified that we saw the order as the other nurse wrote it. She (the other nurse) remained responsible for the order she recieved and transcribed. You can verify that everything matches to the order that the other nurse took....unless there is a poilcy against it. It really depends on how your CPOE is regulated within that facility. All that you are verifying is the everything matches to the order in the computer not that the order placed in the computer by someone else is correct. Going to all computers has issues when no pharmacy or MD's in house in smaller facilties phone orders arew more common, ask your manager to show the policy on how this situation should be handled.

[psu_213, BSN, RN]

I'm a bit confused here. Let's say a nurse, at the end of his/her shift, takes a phone order for a medicine (let's say a PRN blood pressure med). Where I worked, the order was faxed to the pharmacy and the put it on the MAR. As the next nurse, would you not verify that order? Why not? Not trying to sound accusatory...just trying to determine the process and your thinking on the matter. Would you not give the first dose of a medicine that was ordered via a phone order taken by another nurse if the doctor had not yet signed the phone order?

[Night Owl RN]

In our computer system, we are just verifying that we saw the new order. After it is verfied by the floor nurse, the order goes into the appropriate ques. If it's for a med, the pharmacy must review and release it.

[Good Morning, Gil]

if it's a telephone order, you write it down and then you can check it against the order you wrote against what pharmacy sends to you before verifying it. If the physician wrote it, you check the original order against what pharmacy enters on the e-mar. If everything is correct, you verify it. If something does not match up (wrong time, wrong route, wrong drug, etc, you do not verify it, but clarify it.

[MomRN0913]

Yes, the nurse just enters the order from a verbal or telephone order. Nothing is written down.

this seems odd. Where does a doctor write his order?

[Esme12, ASN, BSN, RN]

this seems odd. Where does a doctor write his order?

Some places still use paper......

ps. (I mean that tongue in cheek;))

[jimthorp]

I feel

uncomfortable verifying an order that I did not personally take.

Generally speaking I feel the same. However, I work with a few nurses who I trust completely.