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02/20/19 MD -- Verbal / Telephone Orders

From: Mary Dang

To: Pharmacists

Sent: Wednesday, February 20, 2019 1:02:56 PM

Subject: Fwd: Verbal / Telephone Orders

FYI... please see e-mail message below.

Mary

Mary Dang, Pharm.D.

Manager of Pharmacy Professional Services Huntsville Hospital, Department of Pharmacy

Office: 256-265-2492

Mobile: 256-337-6190

Fax: 256-265-2155

----- Forwarded Message -----

From: Jeff Samz

Sent: Tuesday, February 19, 2019 2:46:58 PM

Subject: Verbal / Telephone Orders

To:         HH Nursing Staff

               HH Medical Staff

From:    Robert Chappell, MD

               John Fanning, MD

               Roger Coomer, MD

               Karol Jones, RN

               Tracy Doughty, RN

               Jeff Samz

Date:     February 19, 2019

Re:         Verbal/Telephone Orders

After a full week’s experience with 1Chart (Cerner), we need to clarify our approach to verbal/telephone orders .  Our policy must be guided first by patient safety and thereafter by making the process as efficient as possible for both nursing and the medical staff.

Modern EHRs use CPOE as a tool to improve patient safety.  Order entry is designed to be done by providers and learning that system is a requirement to practice at HH .  The alerts (for example, medication interactions) that pop up during order entry are designed to improve patient safety, constitute medical decision making and as such, cannot be resolved by nursing without guidance from an appropriately credentialed provider.  During 1Chart training, nurses were told to require physicians to enter the orders themselves if they have access to a computer, and to take verbal/telephone orders sparingly and only if the physician did not have access. 

This memo is intended to update that policy and hopefully make the process smoother for everyone .  Going forward:

•         Nursing may accept verbal/telephone orders for urgent or emergent patient issues where a delay due to the technology could impact patient care.  Examples include pain medication needed or kayexalate.

•         Nursing may accept verbal/telephone orders in small quantities (five or less) to avoid delays in patient care while we are adjusting to the new system .  In most cases, the physician must stay on the phone with the nurse while the order is entered to resolve any alerts that pop up during the process.

•         Nursing may not accept verbal/telephone orders for an entire order set or PowerPlan .  There are too many medical decisions to be made during this process for it to be done safely over the phone.  If the physician is outside of the hospital, they should use one of the remote access tools (please contact Meredith McMinn at meredith.mcminn@hhsys.org if you need help with this) or physically come to the hospital.

We ask that everyone be patient with one another as we learn the new system together.

We insist that everyone treats each other with respect.  Frustration is to be expected.  Being verbally abusive because of that frustration, however, is completely unacceptable and should be reported immediately.

Within the next two weeks, we expect Cerner’s iPhone order entry application (PC Touch) to be available and believe it will offer a convenient option for routine order entry.  Please note that PC Touch is not available on the Android platform and does not accommodate PowerPlans or completing medication reconciliation (those tasks can be completing remotely via a remote desktop).

If you feel you need additional training, nurses should contact their supervisor and physicians should contact the medical staff office.

Thank you to everyone who has worked so hard to make this change a success.