Appendix N – Verbal Orders Process Clarifications for Nurses and Physicians
Verbal Orders Process Clarifications for Nurses and Physicians (Attendings & Housestaff) Verbal orders (VOs) have an inherent degree of risk of error. While VOs are sometimes needed, it is important that the process build in safeguards to reduce risk. Optimal verbal order processes are built on mutual trust and respect between nurses and physicians. A collaborative process with built in checks and precautions is important. VOs should be limited to urgent situations where immediate entry of orders into Epic is not feasible. MD When to use: • Should use sound judgment about whether it is impractical (per policy) to enter order into Epic. (e.g., in a procedure, tied up in an emergency, on call out of hospital.) • NOT for simple convenience • Explain why a VO is needed. Remain on the phone long enough for “read back” to be completed Epic generated alerts may result in page back to clarify Verbal Orders should not be used for: • Blood transfusions (Type and hold and Massive Blood Transfusion Protocol OK) • New PCA order • Admission orders • Order sets • Chemotherapeutic agents Use safety practices when giving order: • Double ID of patient: name, MR# • All parts of drug order (name, form, dose, frequency, route, duration) • Spell out names of drugs • Say units, not abbreviations (e.g., milligrams, not mgs) • Say number digits (e.g., “fifty” becomes “Fifty - five zero”) • Avoid abbreviations (e.g., every six hours - not q6 hours) All VOs must be cosigned: • Cosign within 48 hours – best on same day
RN Will accept verbal order in good faith that there is compliance with the Hospital policy/procedure.
Always perform a “read back” Enter order into Epic as soon as possible; clarify any Epic generated questions with MD Verbal Orders should not be used for: • Blood transfusions (Type and hold, MTP OK) • New PCA order • Admission orders • Order sets • Chemotherapeutic agents Use safety practices with “read-back”: • Double ID of patient: name, MR# • All parts of drug order (name, form, dose, frequency, route, duration) • Spell out names of drugs • Say units, not abbreviation (e.g., milligrams, not mgs) • Say number digits (e.g., “fifty” becomes “fifty - five zero”) • Avoid abbreviations (e.g., every six hours - not q6 hours)
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