All providers are reminded that it is BWH policy to only use verbal orders in emergency situations. This policy is intended to minimize medication errors. The following contains useful information on current BWH policy and recommendations from the Institute for Safe Medication Practices (ISMP) on the subject of verbal orders.
1. BWH Policy
Verbal orders may be accepted by a registered nurse or registered pharmacist, from a physician, nurse practitioner, certified nurse midwife, or physician assistant only in an emergency situation and must be countersigned by the physician/nurse practitioner/certified nurse midwife/physician assistant within 24-hours. Under no circumstances, including an emergency, may anyone other than a registered nurse or registered pharmacist accept a verbal order.
2. Institute for Safe Medication Practice Recommendations
(excerpted from the January 24, 2001 issue) PROBLEM: Verbal orders - orders that are spoken aloud in person or by telephone - offer more room for error than orders that are written or sent electronically. The interpretation of what someone else says is inherently problematic because of different accents, dialects, and pronunciations. Background noise, interruptions, and unfamiliar terminology often compound the problem. Once received, verbal orders must be transcribed as a written order, which adds complexity and risk to the ordering process. The only real record of the verbal order is in the memories of those involved. When the recipient records a verbal order, the prescriber assumes that the recipient understood correctly. No one except the prescriber, however, can verify that the recipient heard the message correctly. If a nurse receives a verbal order and subsequently calls it to the pharmacy, there is even more room for error. The pharmacist must rely on the accuracy of the nurse's written transcription of the order and the pronunciation when it is read to the pharmacist.
3. Recommendations (excerpted):
- Prescribers must enunciate verbal orders clearly and the receiver should always repeat the order back to the prescriber to avoid misinterpretation.
- When providing dosing information always distinguish numbers for the recipient that may be confused like fifteen and fifty. Stating the number fifteen as one, five and the number fifty as five, zero can do this.
- Ensure that the verbal order makes sense in the context of the patient's condition.
- Record the verbal order into the BWH Order Entry System as soon as possible.
- Obtain the phone number or beeper number of the prescriber in case it is necessary for follow-up questions.
- The receiver should take off or acknowledge the order according to established procedures.
- The prescriber must co-sign the order in Order Entry within 24 hours, otherwise the order will be discontinued.
- Verbal orders for chemotherapy are not permitted due to their complexity and potential for tragic errors.
If you have questions regarding this safety update or other safety issues, please call or email
Carl Stapinski, RPh, BWH drug safety pharmacist; Tejal Gandhi, MD, MPH director, Patient Safety; or Erin Graydon-Baker, patient safety manager.