Verbal order policies: Tips for updating policies to reflect requirements

Nurse Leader Insider, December 18, 2006

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Verbal orders can be problematic, so hospitals should be careful to follow verbal order requirements from three areas: the Centers for Medicare and Medicaid Services (CMS) hospital Conditions of Participation (CoP), the JCAHO's standards, and the JCAHO's National Patient Safety Goals.

Well-written verbal order policies can meet all three requirements, according to Sue Dill, RN, MSN, JD, director of hospital risk management for OHIC Insurance Company in Columbus, OH. The National Coordinating Council for Medication Error Reporting and Prevention is a good place to start, she says, because they have recommendations for hospitals in revising or writing their verbal order policies.

Policies should be updated to reflect all requirements, Dill says. They should describe the prohibitions on the use of verbal orders and they should list the elements required for inclusion in a verbal order. For example, a verbal order for medication should include complete information, such as the name, dose, frequency, and route.

Your policies also must define who may send and receive orders. Describe situations in which verbal orders may be used, Dill says, and remember that CMS never allows verbal orders for the convenience of the physician; they are only used when the practitioner is unable to write the order. If a physician is standing in the nursing station, then giving verbal orders is prohibited by federal law, absent an emergency. Verbal orders are appropriate if the physician is in his or her office and providing an order over the phone to the nurse at the hospital.

CMS also states that questions about verbal orders need to be resolved prior to preparation or administration, so be sure to include that, too. CMS also permits a physician's partner to sign off on a verbal order (not a physician's nurse practitioner or physician assistant).

CMS requires that all orders be authenticated and marked with the date and time when the physician signs off on his or her verbal orders (many hospitals get cited by the state department of health for failure to time the verbal order when the order is authenticated).

Editor's note: This excerpt was adapted from Briefings on JCAHO, December 2006, HCPro, Inc.

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