Ward Class

An Online Resource Site For Student Nurses

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Ward Class is an online resource for student nurses. Created with the aim of helping student nurses cope with the demands of nursing school and clinicals, it offers free downloads, notes, sample NCPs, sample drug studies, study aids, news and updates, and practical tips to its users.

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The December 2012 PRC Nursing Board Exam Result is already available here at Ward Class and at Pinoy R.N.




Telephone Reports and Orders

Nurses often communicate with physicians and other healthcare professionals by telephone. Oftentimes, telephone communication is the swiftest method of accomplishing tasks such as reporting changes in the client's condition to the physician, obtaining client data, and facilitating client transfers from one unit to another. Since there are legal risks involved when reporting or receiving orders through telephone, measures to ensure client safety should be instituted.

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:
  1. The attending physician determines that the client needs intervention and that telephone communication is the fastest method of communicating the medical order.
  2. Only in extreme emergency should a nurse receive telephone orders and when no resident is around to receive the said order.
  3. 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.
  4. 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.
  5. 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).
  6. 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.
  7. The nurse documents the telephone order in the nurses' progress notes immediately after the call.

To avoid misunderstanding and misinterpretation that may harm the patient, hospitals should enforce clear-cut policies regarding reporting or taking orders by telephone. Ergo, in line with every agency's intention to ensure client safety, only experienced, licensed , and duty-bound personnel should be allowed to make reports or receive orders by telephone.

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