Telephone orders

Question 1

examples of times you would need to take telephone orders:

Answer 1

> when a new PT is admitted to the ward
there is a serious change in the PTs condition
a PT needs a medication that is outdated or has not been recorded

Question 2

Follow these steps to ensure you get the telephone order efficiently and accurately: 7

Discuss the process of obtaining physician phone orders…

Answer 2

1) prepare yourself
> anticipate the info needed by doc
> have the relevant data avail for reference ex. PT chart, MAR, latest vitals and test results

2) IDy the hosp, ward and self at beginning of the call
> the physician needs to be sure that the person phoning is responsible and appropriate.

3) IDy the PT
> give brief hx. reason for admission, mjr health probs, medical hx

4) state the current PT prob and you request clearly and concisely
>include relevant data and recent observations at that time

5) write all orders given on a scrap piece of paper

6) repeat all orders back to the physician
> to be sure you heard correctly
> also gives the physician time to review the appropriateness of the orders

7) once off the phone, record the orders on the physicians’ order sheet
> transcribe the orders immediately

Question 3

what are the 5 modalities according to physician preferences, if known. wait no longer than 5 min between attempts

Answer 3

1. Direct page (if known)
2. physicians call service
3. during weekdays, the physicians office directly
4. on weekends and after hours during the week, physician’s home phone
5. cell phone

for emerg situation and physician is not responding, use approp resident service as neeed to ensure safe PT care

Question 4

prior to calling the physician, follow these steps

Answer 4

1. have i seen and assessed the PT myself bfr calling?
2. has the situation been discussed with resource nurse or preceptor?
3. review the chart for approp physician to call.
4. know the admitting diagnosis and date of admission
5. have i read the most recent MD progress notes and notes from nurse who worked the shift ahead of me?
6. have avail the following when speaking with the MD
   > PT chart
   > list of current meds, allergies, IV fluids and labs
   > most recent vitals
   > reporting lab results: provide date and time the test was done and results of previous test for comparison
   > code status

Question 5

SBAR

Answer 5

Situation
Background
Assessment
Recommendation

Question 6

Situation

Answer 6

what is it?
> IDy self, unit, PT, room #
> brief state prob, what is it, when happened, how severe

Question 7

Background

Answer 7

> admit diagnosis and date of admission
> meds, IV, allergies, labs
> vitals
> lab results: date and time for compare
>other clinical info
> code status

> mental statue, LOC, skin, on O2?

Question 8

Assessment

Answer 8

what is the nurses assessment of the situation?
the problem seems to be:
> cardiac
>neurological, infection, resp, …

Question 9

Recomendation

Answer 9

what does the nurse want?
Ex.
> notification that PT has been admitted
> PT needs to be seen now
> order change

I suggest that you transfer/talk to/refer PT
Is there any tests needed? CXR, ABG, ECG, Lytes?