Getting a verbal order? Take these precautions
Getting a verbal order? Take these precautions
Have you ever disagreed with a physician about the exact words that were used with a verbal order he or she gave?
"I have seen circumstances where a nurse gave an incorrect dose — epinephrine is a big one that comes to mind. And when a problem arises, the doctor and nurse disagree on the source of error — 'I didn't say that!'" says John Burton, MD, residency program director for the Department of Emergency Medicine at Albany (NY) Medical Center.
This miscommunication is one reason that verbal orders should used as rarely as possible, he says, "but truly emergent situations will always require these."
Cherie Blaesing, RN, ED nurse at SSM DePaul Health Center in Bridgeton, MO, agrees. "Ideally, we want the physician to write the order down and enter it in the computer so there is no chance of miscommunication," she says.
If you do take a verbal order, Blaesing says to write it down on an order sheet and then read it back to the physician to make sure it is accurate.
When an ED physician gave Blaesing a verbal order to start a patient on a nitroglycerin drip at 10 mg, she read back the order. "I told him, 'We usually start at micrograms,' and he said, oh yeah, that is what he wanted. That would have dropped the patient's blood pressure to dangerous and potentially fatal levels," she recalls.
Another time, Blaesing was given a verbal order to start a patient on hydroxyzine intravenously (IV), "but we do not give that medication through IV because it can cause hemolysis," she says. "I clarified this with the physician, and we gave it as an intramuscular injection instead."
The above examples show that "even physicians can make a mistake," says Blaesing. "That's why as nurses, we should be listening closely and speak up if something does not sound right. It is OK to question an order if it does not make sense."
Complete the 'circle' when checking back Most ED nurses would agree that a "check-back" process should be used for verbal orders — if a physician orders "5 milligrams of morphine IVP [intravenous push] for Mr. Smith," the nurse would state aloud "5 milligrams of morphine IVP for Mr. Smith." "This is absolutely necessary, but it is only half of the circle for safety when dealing with verbal orders," says Katie Ryan, RN, BSN, director of the ED at St Rose Dominican Hospitals — San Martin Campus in Henderson, NV. Ryan says the circle must be completed by the physician acknowledging the check-back from the nurse. When the nurse verifies the 5 mg morphine order for Mr. Smith, the physician verbally acknowledges, "Yes, that is correct." "Working as a team, the emergency room physicians and nurses must work together to create safety when dealing with verbal orders, by committing to closed circle communication," says Ryan. |
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