Verbal Orders, Read Back Protocol Can Reduce Error Rate To Zero
Verbal orders, including telephone orders are frequently misinterpreted and can lead to significant patient harm. Healthcare facilities in Pennsylvania have reported dozens of cases to the Patient Safefy Authority in which misinterpretation of verbal orders resulted in serious medication overdoses and in patients
receiving the wrong drug.
In a recent study, one hospital found an error rate of 9% with verbal orders. They reduced this error rate to zero by implementing a read back protocol.
Who all can give Verbal Orders
Verbal Orders shall be given only by qualified physicians, dentists, podiatrists, or other persons licensed and authorized / approved as a member of the medical staff of this Hospital. Relaying of a verbal order by a Registered Nurse, Licensed Vocational Nurse, or Physician Assistant who is the direct representative of the prescribing physician will be accepted.
The following staff members can accept and transcribe verbal orders for patients under their care or within the scope of their professional practice,
– Registered Nurse
– Licensed Vocational Nurse
– Certified Physician Assistant
– Registered Respiratory Therapist
– Licensed Rehabilitation Therapist
– Registered Pharmacist
– Registered Dietitian
verbally communicated order must contain all components of a valid written order as outlined in this policy. In addition, it must bear the name of the person who issued it, as well as the name and title of the person who received it.
Process for accepting a verbally communicated order
The listener will concurrently transcribe the order on a sheet with at least the patient’s name and one other identifying type of information (medical record number, room number, date of birth).
Read the transcribed order back to the giver to ensure the listener has properly heard and understood the communication. Enunciate what is being said as clearly as possible.
Immediately place the transcribed order in the medical record.
Due to the risk for medication errors associated with verbal/telephone communication of orders, it is expected that the following components of the order will be verbalized and transcribed:
– Date and time of order
– Generic and brand name of drug
– Drug dosage (strength and concentration)
– Quantity and duration
– Route of administration
– Frequency of administration
– Age and weight of patient (required for Pediatric patients and in clinical circumstances where appropriate)
– Known allergies
– Reason drug is ordered for PRN orders
– Specific indications for use, as appropriate