Typically, medication orders are written and signed by the prescribing practitioner. However, when the prescriber is unavailable to write an order, such as in the event of an emergency, a verbal order, delivered in person or as a "telephone order," may be given to a registered nurse, pharmacist, or other personnel authorized to receive verbal orders. A verbal/telephone order is given orally instead of via documentation. Because of the potential for error with verbal orders, The Joint Commission recommends the following guidelines for the person accepting a verbal order:

1. Document the order carefully and legibly as the order is being delivered. While writing the order, ensure that all components of a medication order are included.
2. Recite the order back to the prescriber.
3. Ask the prescriber to verify that the order is correct.

Example: Dr. Lucille Waterman delivers a telephone order to the nurse caring for the patient, Lewis A. Clarke. The patient is confirmed by stating the full name and DOB. TJC's guidelines for accepting a verbal order are applied as follows:

1. The prescriber states the order, "Dilaudid 2 mg by mouth as needed for severe pain." The nurse documents the order as stated, leaving a space for frequency because it is recognized that that the frequency is missing. The nurse asks the prescriber, "How often can the medication be given?" The prescriber indicates, "every 4 hours," and the nurse writes the complete order.
2. The nurse recites the complete order back to the prescriber: "Dilaudid 2 mg PO q4h prn for severe pain."
3. The nurse asks the prescriber to verify the order, "Is the order I've stated for Lewis A. Clark correct?" The nurse documents the date and time that the order is received and labels the order as a verbal/telephone order with a V.O. or T.O. or per agency policy. The nurse signs the order, and the prescriber must cosign the order when available to do so, usually within 24 to 48 hours, per agency policy.

LEARNING ACTIVITY 4-4 Answer the questions regarding the verbal order, "Give Paul M. Smythe diphenhydramine IV stat."

1. Cite three guidelines for accepting verbal orders.

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2. Which additional information should the nurse request from the prescribing practitioner?

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