IPSG 2 : Improve effective communication

Question 1

Are verbal/telephone orders
prove effective
allowed? What are verbal/telephone
munication
orders allowed for?

Answer 1

Verbal medication orders are allowed on the following situation:
-Resuscitation/urgent situations where an immediate written order is not feasible
-When MAR is down
-Administering IV D10% during hypoglycaemic situation
-Ordering no of units of blood and blood products
-Communication of critical lab results(downtime), Modification of medication orders ex. Pharmacist calls
DR to verify orders.

Question 2

When Verbal order should not be allowed?

Answer 2

When order involves for the Controlled drugs, chemotherapy drugs, Intravenous medications(excludes intravenous fluids), antibiotics

Question 3

Verbal Order Process

Answer 3

*Must be receive by 2 RNs or 1 RN and a PEN who act as witness
1) 1st RN listen, write quantity, duration ,dr down on IMR/ hardcopy downtime EMR with 2nd RN, repeat order back to Dr
2) Dr must repeat order to 2nd RN/PEN
3) Must include date and time or order, drug name, dose, frequency and route, quantity, duration, dr name and mcr no.
4) Administer drug
5) document in case notes
6) Dr must countersign within same shift or <12 hrs
7) RN to ensure all orders are transcribe into EPIC after system recover

Question 4

What is the process of critical lab results?

Answer 4

Received a call from lab, confirm the name and identity of the patient.
Record down the diagnostic test results. Read back the result to reporting staff and document the name of lab staff who is reporting. Indicate that result was “read back” for confirmation with the lab staff on critical results template, “spell back” when needed. Inform Doctor must be MO or above immediately and carry out the intervention within 1hour for inpatient, 2 hours for outpatient.

Question 5

What information is handed over when patient is transferred from one area to another?

Answer 5

-Handover the patient’s details.
A&E dept to ward: —-Department’s treatment summary, Patient’s condition, treatment given, A&E dept records, Xrays, lab results, handover checklist
- ICU to ward: ICU transfer summary IN EMR(EPIC) handover checklist in transfer navigator
-Ward to ward: Transfer summary, EMREPIC) or inpatient clinical notes(downtime), Handover form from Intra and inter hospital(downtime)
- OT to ward: Handover checklist IN EMR(EPIC), Post op instructions, PACU
notes section sign off
- DDR to ward: Post procedure instructions to Ward staff

Question 6

How nurses communicate with doctors?

Answer 6

-Using SBAR

1.Non Urgent/non critical situation
-RN can send message to inform dr if dr never reply call him/her after 15 minutes
-can be attended/reviewed within 4hrs
-matters can be attended within 4hrs e.g. non urgent Xray
-See blue letter or AHPs reply.

2. Urgent/ critical situation to call Dr directly. ( patient is not well, need to be reviewed by Dr asap)
   - Escalate every 10mins if not reply
   ( MO - REG - Consultant)