APPENDIX O–VERBAL ORDERS PROCESS CLARIFICATIONS FOR NURSES AND PHYSICIANS

Appendix O–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. Will accept verbal order in good faith that there is compliance with the Hospital policy/procedure.

Remain on the phone long enough for “read back” to be completed Always perform a “read back”

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)

RN

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) All VOs must be cosigned: • Cosign within 48 hours –best on same day • Team member should sign if MD off service, or otherwise not available Education by MD leaders: • When VO appropriate • Name & SID required • Read back required • Orders not allowed as verbal • Safety practices • Cosign w/in 48 hours; same day cosign is best practice • Any member of team should cosign • Use caution to avoid errors Cosign compliance management: • Regular data reports at specialty and individual level • Physician leaders/program directors improvement strategies • Say number digits (e.g., “fifty” becomes

“fifty -five zero”) • Avoid abbreviations (e.g., every six hours -not q6 hours)

Education by RN leaders: • Name & SID required • Perform read back • Orders not allowed as verbal • Safety practices • Only if immediate need • Use caution to avoid errors

Cosign compliance management: • Not RN management responsibility

V6 10/19/18

(This table does not apply to pharmacists who have their own standard work.)

These changes were created by a joint GME, nursing and physician work group with pharmacy input: Neera Ahuja, MD, Hospital Medicine Division Chief Gretchen Brown, RN, Nursing Director Janjri Desai, PharmD, Assist Dir Pharmacy Sharron Hampton, RN, Nursing Director Joe Hopkins, MD, Assoc CMO Larry Katznelson, MD, Assoc Dean GME Marc Melcher, MD, General Surgery Residency Program Director Elisa Nguyen, RN, PCM G1 –H1 Topher Sharp, MD, CMIO Julie Tisnado, RN, Nursing Director Hirut Truneh, RN, Nursing Director