A review of verbal order policies in acute care hospitals.
ABSTRACT Although verbal and telephone orders (VOs) are commonly used in the patient care process, there has been little examination of the strategies and tactics used to ensure their appropriate use or how to ensure that they are accurately communicated, correctly understood, initially documented, and subsequently transcribed into the medical record and ultimately carried out as intended. A systematic review was conducted of hospital verbal and telephone order policies in acute care settings.
A stratified random sample of hospital verbal and telephone order policy documents were abstracted from critical access, rural, rural referral, and urban hospitals located in Iowa and Missouri and from academic medical centers from across the United States.
Substantial differences were found across 40 acute care settings in terms of who is authorized to give (including nonlicensed personnel) and take VOs and in terms of time allowed for the prescriber to cosign the VO. When a nonphysician or other licensed prescriber was allowed to communicate VOs, there was no discussion of the process to review the VO before it was communicated in turn to the hospital personnel receiving the order. Policies within several of the same hospitals were inconsistent in terms of the periods specified for prescriber cosignature. Few hospitals required authentication of the identity of the person making telephone VOs, nor the use of practices to improve communication reliability.
Careful review and updating of hospital VO policies is necessary to ensure that they are internally consistent and optimize patient safety. The implementation of computerized medical records and ordering systems can reduce but not eliminate the need for VOs.
Full-textDOI: · Available from: Justin Wade Davis, Jul 25, 2014
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ABSTRACT: This study was undertaken to measure the medication error rates associated with verbal orders compared with handwritten and computer-entered orders in an acute-care children's hospital. All medication and intravenous fluid orders for a 3-month interval were entered into a computer database. For the same interval, all errors pertaining to the transmission of a medication or intravenous fluid order were also entered into the database. Errors were detected by the hospital pharmacy, which continuously reviews all inpatient medication and intravenous fluid orders for potential errors before dispensing. Errors were also detected by nurses on the floors, who submit incident reports when medication or intravenous fluid errors occur. Verbal orders were associated with significantly lower error rates than either handwritten orders or computer-entered orders (2.6, 8.5, and 6.3 per 1000, respectively), with transcription errors and dosage errors in particular being reduced. Total error rates did not differ between residents and attending physicians. Error rates did not differ between verbal, written, and computer orders for medications with a low frequency of verbal orders and therefore presumed greater complexity. However, the verbal order error rates seemed more sensitive to order complexity than order error rates in general. The hypothesis that verbal orders are more prone to transmission error than written or computer orders is not supported by the findings in this study. Identifying medications with high levels of order complexity for restriction of verbal order use seems justified. Suggested guidelines for verbal order transmission are presented.Archives of Pediatrics and Adolescent Medicine 01/1995; 148(12):1322-6. · 4.25 Impact Factor
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