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IDEALLY, YOU SHOULD accept only written orders from a health care provider. However, telephone orders are sometimes necessary and permissible when:


* the patient needs immediate treatment and the prescriber isn't available to write an order


* you're providing care to the patient at home (If so, the orders must be signed by the health care provider according to state nursing practice regulations. Under Medicare guidelines, verbal orders must be signed within 30 days. Other agencies impose their own, stricter rules. Failure to obtain a signed order could jeopardize reimbursement.)


* new information (lab data, for example) has become available and the telephone order will let you expedite care (see Taking telephone orders).



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From phone to paper

You should always get telephone orders directly; they should never go through a third party. Carefully follow your facility's policy for documenting these orders. Usually, you'll follow this procedure:


* Record the order word-for-word on the health care provider's order sheet or enter it into a computer. First, note the date and time. On the next line, write "telephone order." (Don't use P.O. for phone order-it could be mistaken for "by mouth.") Then write the health care provider's name, and sign your name.


* Read back the order and get confirmation from the person who gave the order. (This step is called the "Joint Commission read-back requirement" and applies to all verbal and telephone orders. The read-back requirement also applies to critical test results reported verbally or by telephone.)


* If you're having trouble understanding the health care provider, ask another nurse to listen in as you take the order. Then have her read it back and sign the order too.


* Draw lines through any blank spaces in the order.


* Make sure the health care provider countersigns the order within the time limits set by your facility. Without this signature, you may be held liable for practicing medicine without a license.


* Ask the health care provider to fax you a copy of the order (if your facility's confidentiality policy permits this) to save time and help prevent errors. To protect the patient's confidentiality, wait at the fax machine for the transmission. LPN

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Selected references


Charting Made Incredibly Easy!!, 3rd edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2006.


Complete Guide to Documentation, 2nd edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2008.