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I work at a facility for disabled adults. I don’t think our protocol for when there is a problem with a resident after hours is legal. What do you think?



Dear Nancy,

I am a consultant at a facility for physically and mentally disabled adults. The facility employs LPNs to provide care, dispense meds and do treatments, and there is a physician available. When something happens to a resident after regular business hours, the nurse on duty contacts the LPN supervisor on-call to advise of the situation with the resident, then the supervisor contacts the physician. The physician gives the supervisor the order, the supervisor calls the nurse on duty, who then writes the order and carries it out. The order goes from the physician to the supervisor who are both off-site, then to the nurse who is on-site, all verbally. I have argued that this is illegal, but to no avail. Is this legal?


Dear Donna replies:

Dear Hillary,

The topic of who takes verbal orders and who documents them in the patient record has been the subject of at least one other response, which was posted in this column on April 24. You might want to review that response for additional information.

The person taking the verbal order should be the one who documents it in the patient record. Any other format, including the one you describe in your question, creates the potential for the order to be misinterpreted, inaccurate or unclear. Moreover, if the nurse receiving the order has questions about the order or needs clarification about what is ordered, there is no provision to do so. The facility should have a policy on verbal orders based on standards of practice and the nurse practice act and rules. It may be that this procedure for verbal orders is based on some standard of practice and/or the limitations or requirements of the nurse practice act, but that is something only a nurse attorney or attorney in your state can advise you about.

Also of concern is the fact that there is no mention of an RN in the process of obtaining verbal orders. You did mention nurses a few times in your question, but began by saying that LPNs provide care, so it is assumed the nurses are LPNs. If this is the case, another important question arises — where is the RN in this equation?

The response posted on April 24 lists some references on documentation that might be helpful to you in raising your concerns with your employer.



About Author

Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.

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