Open Forum

Hi, what is your stance on having nurses take verbal orders in a busy clinic to help with throughput and clinic flow? Do you allow them, or do you have parameters as to when they can be used? 

We have a policy that only allows verbal orders in the case where it would be to the detriment of the patient if the provider stopped what they were doing to put the order in. Our ACNO and CNO have said that clinic flow does not qualify in this case. We use standing orders heavily for this. I am very involved with the creation and management of our outpatient standing orders. Happy to discuss and see if this might help your clinic flow.

Torie.bonnet@unchealth.unc.edu

We do not allow verbal orders unless it is a STAT/Rapid Response. We have a physician medication box with certain medications (Epi pins, IM Steroids, Albuterol, ASA, nitro, ect) in it use for these instances. 

We do not allow them unless in an urgent or emergent situation. If you are on EPIC, we have recently implemented the "pend and send" functionality to help us keep verbal orders at bay. Thus far, it has made a big impact on reducing verbal orders. Biggest learning curve is making sure providers understand that a pended order is not actionable until signed. Hope that helps!

Thank you for sharing your best practices, Calli! We have proposed/co-sign required in Cerner, and it sounds like it makes throughput challenging. 

In our organization, no nurse including RNs can take verbal orders unless the situation is an emergency.  So no verbal orders for vaccines, etc.. It is never an emergency to give a vaccine....

We have a red emergency locked medication bag.. that it is ok to get a verbal order on....

Our clinical leadership team has developed RN Protocols to address vaccine administrations and common POC testing. We use EPIC; orders can be placed and signed using "Per protocol-no cosign required."  This has streamlined rooming and nurse visits. 

Verbal orders are outside the standard of care EXCEPT for bona fide emergencies, which does not include the provider's convenience. This issue should also be included in the Medical Staff Bylaws of the organization to ensure providers follow and adhere to the organization's policy. Taking a verbal order which results in patient harm or injury will not stand up in the courts so RNs risk their nursing license when doing so.