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- Sep 17, 2009
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This has been a progression I have seen simply become more and more of a malignancy as years pass. This notion that verbal orders (VO) are "highly discouraged" is something that significantly affects how we practice in the department.
A very big distinction that must be made that hospitals, and likely the disjointed commission, are not making is that EDs cannot, do not, and must not be run like any other place in the hospital. As we all know the reasons.
One thing that needs to be addressed is the exponential increase in physician interruption given the lack of availability of verbal orders. Even before, we were interrupted often, sure, but now instead of simply saying yes, or "verbally" instructing the nurse/tech/etc. we have to break what we are doing, go into the EMR and complete the task.
I have on more occasions than I would like to admit, missed doing something on a patient, forgot to order something needed, missed a result, and ordered the wrong med on the wrong pt...these are memorable to me as they happened as I was performing cognitive actions/documenting/reviewing results/ordering on an active pt and had to break stride to worry about having to execute another pt's order myself.
Just wait to do it later..,what happens when we forget. If you are seeing less than one per hour, sure, but when you are slammed, no so easy. And with this attack on the VO, nurses simply let pts languish until I "put the order in". LOS is affected, pt day is affected, and SAFETY is affected.
Luckily I catch most (hopefully all thus far) my mistakes and fix them, but what will it take?
VOs also do not contain the same risk in the ED as the hospital floor. We are always right there next to our nurses. Not a phone call away.
Thumb typed from iPhone using Tapatalk
A very big distinction that must be made that hospitals, and likely the disjointed commission, are not making is that EDs cannot, do not, and must not be run like any other place in the hospital. As we all know the reasons.
One thing that needs to be addressed is the exponential increase in physician interruption given the lack of availability of verbal orders. Even before, we were interrupted often, sure, but now instead of simply saying yes, or "verbally" instructing the nurse/tech/etc. we have to break what we are doing, go into the EMR and complete the task.
I have on more occasions than I would like to admit, missed doing something on a patient, forgot to order something needed, missed a result, and ordered the wrong med on the wrong pt...these are memorable to me as they happened as I was performing cognitive actions/documenting/reviewing results/ordering on an active pt and had to break stride to worry about having to execute another pt's order myself.
Just wait to do it later..,what happens when we forget. If you are seeing less than one per hour, sure, but when you are slammed, no so easy. And with this attack on the VO, nurses simply let pts languish until I "put the order in". LOS is affected, pt day is affected, and SAFETY is affected.
Luckily I catch most (hopefully all thus far) my mistakes and fix them, but what will it take?
VOs also do not contain the same risk in the ED as the hospital floor. We are always right there next to our nurses. Not a phone call away.
Thumb typed from iPhone using Tapatalk
