Wednesday, July 9, 2008

Verbal Orders

From my above post about Doctors and Nurses, I got the comment from Vitum Medicinus asking:

I haven't been on the wards enough to know the rules, but wouldn't this
be in the best interests of the patient ie. so they can get their pain
meds faster??

Just asking, I admit ignorance...

Vitum, I have heard arguments for why verbal orders can be helpful, including such ideas as speed of medication delivery and eliminating handwriting problems, but as a whole verbal orders can be a dangerous thing.

First off, at least in my state in the US, a verbal order has to be written down by a nurse and then read back to the doctor and charted as such, so where a doc could just write "dilaudid 1 mg IV" a nurse would have to write "VORB dilaudid 1 mg IV by Dr. Peel/Braden, RN". So there goes the time-saving thing. Secondly, while there is the potential for me to mis-read a Doc's handwriting (and we have a couple Docs in my ER who I swear write with a pen stuck in their nose just to see if it can be done), there is equally the potential to mis-hear the Docs order as you are writing it. Also, a doc has to sign off on the verbal order at some point, and I have seen it happen where the doc remembers differently than what the nurse wrote down, or where the nurse didn't write anything down so that they could get the medication to the patient faster, and later the doc went in and wrote for different medications.

For my part, unless we are in a code situation (in which case there is a recorder), I hear what the doc has to say, flip the chart to the order page and hand it over. They scribble their note, and then I go get the med. It takes 15 extra seconds.

So in conclusion: If you go and write the order on the chart, then A. there is no need to remember what you ordered, B. There is no need to go back later and cosign it, and C. you know that at least the order was put on paper properly. It takes a few extra seconds, but it is a few extra seconds well-spent.

Of course that is all for the ER. On the floor it is a different story completely, as there are no Doctors hanging out on the floor and so it involves paging and telephone calls and faxes and whatnot, and that is one of the reasons I don't want to be a floor nurse.

1 comment:

Vitum Medicinus said...

Thanks a ton for the detailed response, appreciate the insight!