Would you put your initials on verbal orders?

[Thundercat]

I am currently working at a LTC facility. The DON asked me to go through some of the orders that the doctor either written or ordered verbally to make sure they are correct in the Mar and to put my initial on the orders; however, the problem I have with doing this is that most of the orders are verbal taken by other nurses, some who are no longer working in the facility. The DON keeps persisting for me to do them and not the other staff nurses. I have been off for one week, and when I spoke to her on the phone, she asked if I had went through any of the orders. I believe that she knows the other nurses will not do them, and she doesn't want her initials on the orders as well. The facility is considered one of the worst facilites within the state. Please help! Would any of you guys put your initials on a verbal order that you did not hear?

[crb613, BSN, RN]

Not a chance; no way. Ever.

And if she insists - ask for it in writing.

If she threatens - ask her for her license number for the BON.

If she cries - give her a tissue.

Then tell her to put her own name to it.

I'm with you no way! She must be nuts to think anyone would do something sooooo dumb! Just say NO!

[Batman24]

Not in a million years. PLEASE don't do it.

[VivaLasViejas, ASN, RN]

In a word: No.

In two words: HELL NO!!

There is no safe or legal way that you can sign for an order you didn't take. To do so would be the height of foolishness. I'm presuming you worked hard for your license like I did; I'm also presuming that you know what's right or you wouldn't have asked in the first place.

Your DON is trying to cover her own rear, and don't believe for a second that she wouldn't hesitate to hang you out to dry if something were to go sideways with those orders.

Good luck!

[Straydandelion]

I am guessing your initial is confimation that the doc gave the v.o.? In a hospital setting the doctor has to sign the v.o ASAP usually next time they round. If I were you, I would leave a note to the doctor to ask him to please sign this v.o. and if he doesn't, call his office/fax etc. to get the order signed (at the very least you can rewrite the verbal order after getting it straight from the doctor).

[nurse4sale]

Bottom line. Don't sign anything that you did not do yourself or witness thereof. Everyone knows that chart checks are done by the mid-night nurse.

[scared'o'needles!]

Please don't, there is something very, not right about being asked to do this!

[CathyLew]

Maybe I'm not picturing the situation correctly, but my first thought goes to the almighty fax machine. Couldn't you fax the orders in question to the doctor's office and get the doc's signature on it?

yea, and don't the Dr's have to sign all verbal or telephone orders anyway?

and what does the initial by the order stand for in your facility. If we take a telephone order (we don't allow verbal orders....if the Dr is within ear shot, he should jot down his messy handwriting himself!) but if we take a telephone order, we have to write T.O. Dr. So-and-so/Signature of RN and Read Back. (or R.B.)

so that is the nurse that hears the order, and takes it off. The Ward secretary then gets the chart, does her thing, and puts her initials and date next to the order. The RN who is checking the order (may not be the one who wrote it) checks the order against the computer/kardex and MAR. Then they initial the order and date it.

then at midnight the night RN does a 24 hr chart check. They check the order against what was done. Draw a red line on the order sheet, and put their initial date and time.

so the last three people that initial the chart arn't saying they heard the order or agree that is what the Dr said. They are saying they agree that the order got carried out.

if the order is not signed off in 24 hrs, the next night does a 48 hr chart check.

so does your initial mean that you checked to see that the orders got carried out? If so, date it for the day you checked it. If the initial means you heard the order or took the order, don't do it.

[CoffeeRTC, BSN, RN]

Every so often (besides the monthly checks) we do a chart review. Actually, medical records should do this and sometimes I would do it when I was an RNAC. I would make sure that the orders were taken off, folllowed up on, transcribed to the MAR/ TAR and the labs or what ever were ordered. Never would I inital the order. I would make a list of the errors or discrepancies and then if needed corrrect the issue. If this is what your DON wants...okay....Never initial or sign the actual order. Another nurse should have done it when they got the order and should have written a note about it.

In LTC docs have 48hrs to sign all TO or verbals. Since most docs don't even come in weekly, your facility should have a system to deal with this. We fax the orders right away, the docs will fax them back (same day or next day) and medical records will place the faxed order in the chart.

Reading the post above...yeah..initaling it could mean that you checked the order, I guess it would depend on how your orders are taken off and what your P and P is in your facility.

Bottom line...get the specifics from the DON...why are you needing to do this? If it is like I described above..no the DON doesn't have to do it herself, it can easily be deligated to a nurse (if they have the time) or even medical records.

[kcochrane]

I work in a LTC facility and ALL new orders - either verbal or written have to be initialed, dated, timed and signed for by the nurse that transcribes them onto the MAR. I'm assuming this is what your DON of nursing is asking. She is wrong is asking you to do that. Let's say the state (or pharmacy) decides to do an audit, your info in on the order and you didn't even work that day. Guess you gets in trouble? Check your hospital policy because no supervisor can ask you to go against policy. And when the **** hits the fan, "she told me too" will not save you.

As others have stated, ask her why she is asking you to do that. You can ask in a professional way to find out just what she is thinking. As DON she needs to start auditing the orders more often to see just who is taking off orders and not signing them. For now she should send our a memo to everyone to double check they have done that and give them to a certain date to do it. If she finds it now done after that, write them up.

[kcochrane]

and yes you can sign, date, initial, etc. the order even if the doctor has not yet signed the verbal. So that is not an excuse if a nurse is using it.