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Verbal orders in ambulatory clinics

  • 1.  Verbal orders in ambulatory clinics

    Posted 11-21-2024 18:02

    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? 



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    Jennifer Edwards (Mindala)
    BSN, RN, OCN, LSSGB
    RN Clinical Services Director
    Clinical Services | Navigators
    Banner University Medical Group-Phoenix at Banner University Medical Center Phoenix
    Jennifer.Edwards9@bannerhealth.com
    ------------------------------


  • 2.  RE: Verbal orders in ambulatory clinics

    Posted 11-22-2024 07:12

    We do not allow them at all, with the rare exception of a true medical emergency.

     

     

    Lisa

    _____________________

    Lisa C. Dutton, MSN, RN, AMB-BC, NE-BC

    Professional Development Manager, BWH Department of Ambulatory Nursing 

    Co-chair; MGB Ambulatory Nurse Council

    Clinical Director, MGB Nurse Hotline

    Operations Lead, MGB COVID Outpatient Therapies

     

     

    Brigham and Women's Hospital

    75 Francis Street, Boston, MA 02115

    M: 603-479-7468 T: 617-525-7789

    brighamandwomens.org

     

     

     

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  • 3.  RE: Verbal orders in ambulatory clinics

    Posted 11-23-2024 09:54
    Verbal orders may help with workflow, but have you considered that they will also add to risk management , errors and burnout on the nursing staff trying to remind providers to enter or sign off on the orders? When considering something new that may help administratively, please remember to consider the impact it will have on your nursing staff.  Verbals orders have been severely limited to the adverse effects of the above. The same should be considered in the ambulatory care arena. Remember, the easier you make it for providers to "not be responsible" for what they are supposed to be doing, the less likely they are to get any better at doing it in the future.  As a nurse practitioner, I do not give verbal orders.  Additionally, many physician providers do not appreciate or are aware of the difference in the scope of practice between an RN and the c-MA and may be giving the MA's verbal orders especially since some of them may have access to the RN security levels in the EHR.  This has happened in the several ambulatory setting where I have worked (not recently). Hopefully, it is not an ongoing issue. 

    -mobley


    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 
    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].



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  • 4.  RE: Verbal orders in ambulatory clinics

    Posted 11-24-2024 12:34

    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



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    Torie Bonnet MSN RN NE-BC NPD-BC
    Clinical Nurse Education Specialist
    UNC Health
    Raleigh NC

    torie.bonnet@unchealth.unc.edu
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    Original Message


  • 5.  RE: Verbal orders in ambulatory clinics

    Posted 11-25-2024 09:51

    We allow them.

     

    Dayna Wilson BSN, RN-BC

    Advent Health Med Gp Primary Care @ Highlands Ranch

    9137 So Ridgeline Blvd, Ste 100

    Highlands Ranch, CO 80129

    Phone:  303-649-3149; Fax: 303-649-3154

     

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  • 6.  RE: Verbal orders in ambulatory clinics

    Posted 11-22-2024 09:29

    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. 



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    Stephanie Zollinger RN
    JPS Hospital
    Weatherford TX
    817-907-8954
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    Original Message


  • 7.  RE: Verbal orders in ambulatory clinics

    Posted 11-22-2024 10:49

    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!



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    Calli Wood MSN Ed RN, NPD-BC
    Dir of Nursing
    UT Southwestern
    Coppell TX
    calli.wood@utsouthwestern.edu
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    Original Message


  • 8.  RE: Verbal orders in ambulatory clinics

    Posted 11-22-2024 14:14

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



    ------------------------------
    Jennifer Edwards (Mindala)
    BSN, RN, OCN, LSSGB
    RN Clinical Services Director
    Clinical Services | Navigators
    Banner University Medical Group-Phoenix at Banner University Medical Center Phoenix
    Jennifer.Edwards9@bannerhealth.com
    ------------------------------

    Original Message


  • 9.  RE: Verbal orders in ambulatory clinics

    Posted 11-22-2024 14:37

    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....



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    Bonnie Hooper
    RN
    Primary HealthCare
    Des Moines IA
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    Original Message


  • 10.  RE: Verbal orders in ambulatory clinics

    Posted 11-23-2024 08:09

    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. 



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    Loren Williams RN AMB-BC
    St Peter's Health Partners
    Saratoga Springs NY
    3154399963
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    Original Message


  • 11.  RE: Verbal orders in ambulatory clinics

    Posted 11-23-2024 19:31

    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. 



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    Joan Pate MS BSN AMB-BC
    CAPT
    The Villages FL
    (505) 453-6079
    jmpate@earthlink.net
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    Original Message


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