Tuesday, January 8, 2013

Verbal orders

For those of you in medicine, you surely know that verbal orders can be a lifesaver. If I had to go to a unit every time I wanted a patient to get Tylenol, that would be a massive waste of my time. Instead you can just tell the nurse over the phone to give the Tylenol, then sign the order when you're on that unit.

An attending I talked to recently told me that when he was a resident, the hospital where he trained didn't allow verbal orders. But at the same time, the residents took call from home.

So say a patient had a mild headache and wanted Tylenol. Instead of telling the nurse to give it, you had to drive all the way to the hospital (he lived thirty minutes away) and write the order, then drive home.

He said that it resulted in crazy amounts of PRN orders. He said that the residents would sit there, brainstorming every medication a patient might possibly need during the night, and writing a PRN order for it.


  1. Oh dear God. As an ICU nurse I don't think I could stand to work at that hospital. That would be too terrible for words to wake up a Doc in the middle of the night for that and have them drive on over.

    If I were them though I would have worked on straight up protocols for near everything.

  2. We have an entire folder dedicated to medications nurses are allowed to prescribe "as per standing orders". Like, if someone needs Tylenol, or laxatives, or normal saline for IV antibiotics you can just give it. Saves everyone's time.

  3. I'd never allow a standing Tylenol order. Or Advil. We have too many patients who can't have Advil (eg: Kawasaki disease on high dose aspirin), and likewise for Tylenol (fried liver from antiepilepics). Also those things are given out like candy for "irritability" - a child is irritable because he's sick and in a hospital, and Tylenol is not going to help. That's a pleasant conversation to have at 4am - no, he can't have another Tylenol. Have you tried cuddling him maybe?

  4. I'm not going to lie - during a 6 month stint in medicine/geriatrics i used to do the same: the nurses in this particular hospital wouldnt give any meds at all without a written order - they would even accept telephonic orders! - so everyone would get prn paracetamol, metaclopromide, GTN, and zolpidem. i would obviously still go and see the patient if they needed but but at least they could be getting treatment in the mean time... it also saved me getting up during the only hour that i would be getting to rest on a 36 hour call.....

  5. We do lots of standng prn orders at our hospital, but we also add them individually at each admission and should evaluate the patient's liver function before writi for prn Tylenol, etc.

    1. Yes, although if the patient isn't bright yellow, they can certainly tolerate a one-time 650mg dose :)

  6. *writing, of course. Stupid tablet. Stupid tired intern typing.