When reporting via telephone, the nurse must demonstrate courtesy and professionalism. It is also important to organize information beforehand to ensure that reports made by telephone are brief and clearly understood by the receiver. For instance, when reporting changes in the client's condition to the attending physician, it is prudent for the nurse to review his/her notes and have assessment data ready before placing the call. The nurse should also document in the nurses' progress notes the following: the date and time of the telephone report, the name of the physician the nurse spoke with, the data reported, and any order given by the physician in relation to the telephone report accomplished by the nurse.
Another aspect of telephone communication involves receiving telephone orders from the client's attending physician. Since telephone orders may be subject to misunderstanding and misinterpretation by the receiving nurse, the following must be taken into consideration:
- The attending physician determines that the client needs intervention and that telephone communication is the fastest method of communicating the medical order.
- Only in extreme emergency should a nurse receive telephone orders and when no resident is around to receive the said order.
- Telephone orders should be brief and the person receiving it should read the order to the physician verbatim. When taking medication orders, the nurse should spell the name of the drug to the physician to avoid errors. The use of abbreviations such as "U" for units and "mcg" for micrograms is also avoided.
- When writing down telephone orders in the physician's orders sheet, the nurse should accomplish the following: record the date and time the order was given and write the order as dictated by the physician. The nurse also signs the order beginning with a t.o. (telephone order), the physician's name followed by her (the nurse's) name and signature and the signature of another nurse who witnessed the telephone order.
- The nurse should ensure that the physician countersigns the telephone order within 24 hours (or within an hour for orders of seclusion/restraint or emergency psychiatric medications).
- For physician's orders transmitted via fax, the order should bear the physician's name and signature. The nurse should also call the physician to verify if he or she initiated the order.
- The nurse documents the telephone order in the nurses' progress notes immediately after the call.