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Tip: Avoid noncompliance with written orders

Compliance Monitor, June 30, 2004

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Written orders-taken either by nurse practitioners or physician extenders-and verbal orders from physicians are sources of patient-care compliance concern for many institutions.

Physicians rely heavily on these professionals and the care they provide to patients. Many physicians would rather work with them than with trainees such as residents, fellows, or inexperienced licensed clinicians.

Therefore, it is not unusual for a physician assistant or nurse practitioner to order something for a patient (either pursuant to a protocol or otherwise) without having the order countersigned by a physician, as required by most state laws and for billing purposes under Medicare and Medicaid. But this practice brings patient care exposure and potential billing exposures.

To address this issue, organizations should have detailed written policies and procedures that require countersignatures, in accordance with legal and billing requirements. It is critical to train advanced-practice nurses, physician extenders, and physicians on this topic.

Include staff nurses in this training program, because this group usually carries out the orders and may be able to get them countersigned up front.

Monitor this process by performing regular chart audits to verify the presence of required countersignatures.

This tip comes from Patient Safety Meets Corporate Compliance by James A. Kopf, F. Lisa Murtha, Esq., and Rory Jaffe, MD, MBA. Copyright 2004 by HCPro Inc. For more information, click here.

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