Jerry Fahrni

AMN Healthcare: “A new AHRQ-funded study found that of roughly 973,000 orders that physicians at a large, Midwestern hospital gave nurses over a 12-month period, roughly 20 percent were verbal orders. The hospital transitioned from a paper-based to computerized provider order entry (CPOE) system during the study period. The new study is one of the first to examine how the content of verbal orders or the context in which they are given might increase risk of error. Although more hospitals are converting totally or in part to CPOE, most experts expect verbal medical ordering to continue to be used extensively for the foreseeable future. According to the researchers, who were led by the University of Missouri’s Douglas S. Wakefield, Ph.D., five factors potentially contribute to verbal orders causing medical errors—type of care setting; time of day or week; type of communication and related variables, such as the physician’s and/or nurse’s accent and articulation; the providers’ knowledge of the patients for whom the order is being given and previous contact experience between the physician and nurse; and environment including background noise and staffing levels. The study, “An Exploratory Study Measuring Verbal Order Content and Context,” was published in the April 2009 issue of Quality and Safety in Health Care.” “– There really are very few excuses for giving verbal orders in a facility that utilizes CPOE. A couple that come to mind might be in a true emergency or in the case of a physician being unable to get to a computer. Unfortunately physicians frequently abuse the verbal order system out of laziness, creating a dangerous situation. I’ve had to clarify my fair share of verbal orders that were poorly transcribed from the physicians lips, to the nurses mind, and finally onto paper. There are simply too many variable during the process. It’s like the old game where you start a rumor with one person and have them pass it on to someone else and so on down the line. At the end of the line, you have a garbled mess. Verbal orders are like that. CPOE is implemented as a safety feature to reduce prescribing and transcription error, but to benefit from the feature physicians have to use it.