View Full Version : Beware the Verbal Order!

06-23-2007, 07:20 PM
What you hear may not be what is said.

For example:

MD orders Lasix 80 mg IV for patient in severe pulmonary edema.

You repeat the order back - the doctor is walking out of the room.

Next to the the Pyxis machine you repeat the order again as you look for the med and the doctor is standing next to you talking to you.

You give Lasix 80 mg IV. You go to write the verbal order.

The doctor has written 40 mg, not 80 mg.

You question the order.

Not only did he not SAY Lasix 80 mg, he explains why in this particular case he would NOT have ordered Lasix 80 mg.

Um...he said...I said.....

No fault finding here - just giving an example of how verbal orders are a ripe field for error.

09-12-2007, 09:44 AM
Two scenarios:

1. Dr. ER gives you a verbal order to give Morphine 2mg IV to Patient MI. Nurse Wonderful goes to the pyxis and gets out the Morphine and administers it as per the doctor's order. Dr. ER, in his rush orders Morphine 2mg IV to Patient MI to Nurse Wonderful II, and she obediently obeys his orders. Dr. ER asks out loud, "Did Patient MI get his Morphine, and two nurses answer at the same time, "Yes, I gave it." Each nurse looks at each other with that "ut oh" expression.

2. In the middle of the night, Nurse ICU calls Dr. Neuro to obtain orders for a new CVA. She writes the orders down and then repeats them; sleepily he says "yes, yes, yes." The next morning Dr. Neuro comes in early and asks Nurse ICU who wrote these orders. "I did," she says, "I called you last night and you gave them to me over the phone." Dr. Neuro replies, "I most certainly did not and I refuse to sign them. I was not called by anyone last night." Of course Nurse ICU is furious and goes to her supervisor who ultimately agrees with Dr. Neuro to make him happy. The next night Dr. Neuro calls into the ICU to check in on his patient. Nurse ICU answers the phone and gives Dr. Neuro the patient update. Dr. Neuro wants to leave orders. Nurse ICU responds by saying, "I'm sorry Dr. Neuro, I know it's late but you'll have to come in to write those orders. I took orders from you just last night and you refused to sign them. I wouldn't want to write the wrong orders again. I know it's inconvient but I find it to be necessary." Dr. Neuro hangs up the phone and within 30 minutes arrives at the ICU and writes his orders. Looking at Nurse ICU he apologizes for his blunder and states that he will make it right with her supervisor, and he did.

09-12-2007, 11:40 AM
We used to take phone orders from a neurologist. And then she would come in the next morning and write (in the electronic order system), "Order #165 not given by me."


Several of us would then say, "But yes you did...." and she would still deny it.

So we stopped taking verbal orders from her. She has to come in to write them.

And she does.