Who's right? Verbal order versus fax order

[aphillipi]

New nurse here w question: Earlier today i could NOT get ahold of a doc on the phone for my new ltc pt. so i sent him a fax w standard admission orders, asking him to add anything else he wanted or cross out anything he didnt want. i called the office and gave them heads up and asked if they could have doc look at it between pts. few hours later i get signed orders faxed back - i thik okay great we are all set.

My boss just told me I really messed up by not signing ad writing date and time I sent the fax on the order. She says they aren't official orders and apparently I ruined everything. I tried to explain they weren't verbal orders- why would I sign the spot for verbal orders? But she was adamant that I had initiated the ordrs and that's the date and time that the order should say. ( I had documented the attempts to contact and the fax under communication notes. ) my point is that it could be proven that I had Not talked to the doctor and they were Not official orders until he approved them.

Anyways I feel lousy because I was chastised like a child and I'm pretty sure I was in the right. Any opinions? (Sorry for typos, I'm on my phone) thanks!

[Jory, MSN, APRN, CNM]

No order exists unless the physician is aware of it. You cannot "initiate" an order by sending him a fax. He could have left the office for the day, for the week, he may never check the fax machine and leave that to someone else, etc.

You can put a fax cover sheet and wait for the confirmation page to show that you sent it, but unless he has it in his hands (and a fax confirmation does NOT prove receipt, it only shows the fax machines communicated with each other) and writes something or verbally tells you something, you are no better off than what you were to start with.

So, if someone puts the paperwork on his desk, he needs to sign them and date them for when the orders were written, not when you sent them.

So you are correct.

[Double-Helix, BSN, RN]

I think I see the managers point. Say the patient was admitted to the LTC at 1200 and let's say it was 1400 when you sent the fax and 1700 when you got the fax back. I'm sure that 7 hour period the patient wasn't sitting in a room by herself, right? Vital signs were done, admission assessment, assisted to the bathroom, maybe got something to eat or drink, possibly some Tylenol? Technically there are orders needed for some of those things, right? So if someone were to audit the chart and saw those tasks documents hours before an order was written for them, would that be a problem? (I'm asking, because I'm really not sure how LTC works in that regard.) Is it possible that this is what your manager meant when she said you needed to date and time the fax because these admission orders were technically initiated earlier?

[CoffeeRTC, BSN, RN]

IN LTC, when we get an admit, a lot or re admit it is common for the docs that see them in the hospital to follow in the LTC so it is nice when you have an idea that the orders will be very similar to the ones on the DC orders.

When we have an admit, getting ahold of the doc isn't like what it is in a hospital. It isn't like you are going to get the orders handed to you by ems, call the doc and in 5 or 10 minutes they will be approved and written up and put into action. If I can get this done in an hour I feel like it is Christmas!

What we like to see hapen...social worker or DC planner in hosp faxes us the dc orders and a few basics to get started. Paper work is started before they come..even if it is just putting their name on the 30 or so sheets of assessments and order sheets. Sometime I will get started transcribing them if they are close to dc (these can be changed x'd off if the order changes and chaged when you get the final papers and speak with the doc for the approval)

When they get there you might or might not be a step ahead. When they do come in and you get the papers you review them and call the doc for the approval. It sounds like the OP was meeting a block in this part and just faxed the doc the papers to the office so that doc can review them and the office staff can get the doc to do it (sometimes easier than getting the doc on the phone). Office staff faxed back the orders and the nurse would write it as a verbal? (doc probably signed the faxed sheet?) I can see how technically it isn't a verbal order..is that what the other nurse was getting at?

[morte, LPN, LVN]

I don't think I am getting the problem either. If he sent them back, signed, what is the big deal? it would be a F.O., instead of a T.O.