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Under what circumstances are verbal orders acceptable?

HIM Connection, April 1, 2003

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Dear Colleagues:

If you want to mitigate the problem of verbal order authentication (as well as potential quality and legal problems) then create a policy that limits the circumstances in which verbal orders are acceptable.

But how extreme should limits be? On the assumption that it is unreasonable to prohibit verbal orders entirely, some of the most restrictive policies limit the use of verbal orders to emergency situations only.

A more permissive approach, but one that might reduce the number of verbal orders, would be to allow physicians to issue verbal orders only by telephone, and only when they are off site, unable to visit the patient care unit, and unable to send a written order by fax. This approach worked well, for instance, in a hospital where the problem of unsigned verbal orders stemmed from the fact that nurses accepted verbal orders issued in person--from residents and physicians who were with them on the patient care unit--or telephoned to the unit within the hospital. When the facility changed its policy to allow verbal orders only by telephone from outside the hospital, the number of verbal orders dropped dramatically, which helped resolve the health information management department's authentication dilemma.

The most permissive policies allow physicians to issue verbal orders at any time in any situation-even when they are in a patient's room. Facilities that choose this option should, at the very least, require immediate transcription of those orders, and should insist that practitioners authenticate verbal orders before they leave the unit.

Another effective approach to reducing reliance on verbal orders might be to limit the types of services and procedures that can be ordered verbally. Most often, this means prohibiting the use of verbal orders calling for certain medications, invasive procedures, and other forms of treatment that place patients at risk. In fact, the American Medical Association's policy on drug errors in hospitals urges members to limit verbal orders for medication to situations "in which is it is impossible or impractical for the prescriber to write the order or enter it into a computer." Nurses and pharmacists are able to accurately receive medication orders, for example, the association says.

This tip was excerpted from Reengineering Verbal Orders: New, Team-Based Strategies, a book that offers practical tips on policy development and process redesign, and includes case studies showing how a hospital and a home-care agency tackled these challenging tasks. It will help you satisfy accreditors and regulators and eliminate the bureaucracy and inefficiency that's such a frustrating side effect of verbal orders. It also includes a CE quiz for HIM staff. Click here for more information or to order your copy.

Sincerely,

Laura Motta
Editorial Assistant
lmotta@hcpro.com

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