Stop poor compliance for verbal order standard
Have you struggled with compliance with The Joint Commission's standards for use of verbal orders in your ED? According to the most recent statistics, 40% of hospitals were noncompliant with requirements for qualified staff to record and receive verbal orders (standard RC.02.03.07) during surveys in the first half of 2009.
"We have instructed all of our nurses to keep verbal orders to critical situations only," says Sheri Leslein, RN, CEN, assistant director of the emergency center at Medical Center of Central Georgia in Macon. "If a physician starts to give a verbal order, the nurse hands the chart to them to write it."
Physicians enter all of their own orders into the system, with the exception of medication orders. "This helps a lot," she says. "By October 2010, we will have all of the orders entered into the computer by the physician. Our physicians also carry a telephone to make them easily accessible."
2 nurses perform double-check
A scribe is in the room for critical and emergency situations, which allows two nurses to hear any verbal orders and perform a double-check. "We have the nurse repeat the order when it is heard. If giving the medication, the nurse will repeat the medication and the dose to the ordering physician before giving it," says Leslein. "This read-back and verify process is used for all verbal and telephone orders."
The initial culture change took some time, but it is now ingrained in the practice of ED nurses. "When I first came to the emergency department, it took me a long time to get used to working off verbal orders after coming from the floor where we worked off written orders. I have now come full circle," says Leslein.
Chart audits are performed to ensure compliance with this process. "I review all of the quality improvement referrals, and I have not seen any related to verbal orders since the process was started," Leslein says.
Source
For more information on verbal orders in the ED, contact:
- Sheri Leslein, RN, CEN, Assistant Director, Emergency Center, Medical Center of Central Georgia, Macon. Phone: (478) 633-2038. Fax: (478) 633-7879. E-mail: [email protected].
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