Signing Other Residents Verbal Orders

[imint]

At my hospital if we don't sign verbal orders then the chart goes to medical records and it's a hassle to go down there to sign orders and it could lead to your check being held if you don't do it in a timely fashion. My program constantly tells us that we have to sign our colleagues verbal orders.
Because I'm a team player I do sign them but honestly I don't feel comfortable signing verbal orders given by someone else on a patient I really don't know much about. Also, legally couldn't I get in trouble if something happens and the patient sues and I signed that order? I feel like it's not right that we are forced to do so whether we want to or not. I always go back and sign all my verbal orders and I don't expect anyone else to do so for me.

So what are your thoughts on this policy?

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[silas2642]

At my hospital if we don't sign verbal orders then the chart goes to medical records and it's a hassle to go down there to sign orders and it could lead to your check being held if you don't do it in a timely fashion. My program constantly tells us that we have to sign our colleagues verbal orders.
Because I'm a team player I do sign them but honestly I don't feel comfortable signing verbal orders given by someone else on a patient I really don't know much about. Also, legally couldn't I get in trouble if something happens and the patient sues and I signed that order? I feel like it's not right that we are forced to do so whether we want to or not. I always go back and sign all my verbal orders and I don't expect anyone else to do so for me.

So what are your thoughts on this policy?

I would bring this up with your chiefs... I wouldn't feel comfortable someone else's verbal orders and would likely refuse to do it-- like you pointed out, what if something happened to the patient? Your name would be on the document and you could be liable for something that you had nothing to do with.

 

[FutureInternist]

We only sign the orders on our team's patients (i.e. If the NF intern ordered some lortab etc) and even then only if we agree with it. If not, then we get the original intern to sign the next night.

 

[hot sauce]

I'm confused why you would be signing for verbal orders on other people's patients. I can understand if it an overnight order on one of your usual patients but I don't see why you would be expected to sign orders for a patient that isn't yours. If they are doing that they might as well just have someone who just signs all the orders in all the charts before they go to medical records.

 

[gutonc]

I'm confused why you would be signing for verbal orders on other people's patients. I can understand if it an overnight order on one of your usual patients but I don't see why you would be expected to sign orders for a patient that isn't yours. If they are doing that they might as well just have someone who just signs all the orders in all the charts before they go to medical records.

That's what the OP is likely talking about. Unsigned NF verbal orders on your patients, not random verbal orders on random patients in the hospital.

We routinely did this on the MICU service while we were rounding with the attending. It was part of reviewing the overnight events.

 

[Law2Doc]

We only sign the orders on our team's patients (i.e. If the NF intern ordered some lortab etc) and even then only if we agree with it. If not, then we get the original intern to sign the next night.

This. This only matters at places that still use paper charts, and so the issue will go away altogether in a year or two. Verbal orders allow you to tell a nurse on the other side of the hospital by phone that it's okay to give a patient chlorasceptic spray or some ice chips without trekking all the way over to the patients charts when you have other more pressing things going on. ideally you double back and sign them when you are over there, but on a busy shift you may not ever get over there, so one of your teammates can sign It for you when they are over there. You wouldnt sign something you wouldn't agree with, like a very high dose of a med you don't like to use, but for little things that come up over night or for electrolyte repletion, you should. The nurse is only allowed to take verbal orders if a doctor comes by and signs it within a 24 hour period at most places. Yes you can get sued over orders you sign, so you need to make sure it's not a controversial order, like a whopping dose of morphine to a little old lady. But if a patient has low calcium and one of your colleagues repletes it with a reasonable dose, you do them a solid and sign it when you are over there.

 

[gutonc]

This. This only matters at places that still use paper charts, and so the issue will go away altogether in a year or two.

This is key. I'm kind of amazed that people in training hospitals are still rockin' paper charts at all. My place has been inpatient EMR for 5 years and electronic order entry for 4 years.

Even before that though they had a system in place that when patients were d/c'd and charts returned to medical records, the charts were scanned in their entirety and unsigned orders were flagged. You then got an email telling you about your unsigned charts and all you had to do was log onto this system and go through and sign them. It was a little clunky but way easier than wandering down to medical records in the middle of a busy day and thumbing through a few dozen charts to find the one place you didn't sign an order or note.

 

[FutureInternist]

This is key. I'm kind of amazed that people in training hospitals are still rockin' paper charts at all. My place has been inpatient EMR for 5 years and electronic order entry for 4 years.

Even before that though they had a system in place that when patients were d/c'd and charts returned to medical records, the charts were scanned in their entirety and unsigned orders were flagged. You then got an email telling you about your unsigned charts and all you had to do was log onto this system and go through and sign them. It was a little clunky but way easier than wandering down to medical records in the middle of a busy day and thumbing through a few dozen charts to find the one place you didn't sign an order or note.

I believe JHACO? is mandating computer physician order entry by end of 2012. Right now they are paying bonuses if you do it early, but in 2013 they will start paying out less for each bill if you are still not compliant. Kind of what they do with re-admissions currently

 

[gutonc]

I believe JHACO? is mandating computer physician order entry by end of 2012. Right now they are paying bonuses if you do it early, but in 2013 they will start paying out less for each bill if you are still not compliant. Kind of what they do with re-admissions currently

I am aware of all that, although it's CMS, not JC (there is no longer a group known as JCAHO). I was merely commenting that paper charts and orders are the documentation equivalent of trepanning and should have been gotten rid of years ago.