How common are verbal orders at your facility? How timely are the physicians authenticating those verbal orders? Does anyone other than the nurse entering the verbal order ever check in with the patient to see if the controlled substance ordered and charted as administered was effective?
At most facilities, awareness of diversion is lacking. Because of this lack of awareness, it is seldom considered that a nurse advocating for more medications for a patient may be a way to divert. I have personally seen this method used. I also recently read about a case where a nurse plead guilty to diversion by entering fraudulent verbal orders. These verbal orders being entered may be totally unknown to the physician or may be at the request of the nurse who is untruthful about the patient’s need for the medication. Regardless, it is a fraudulent verbal order. The nurse enters the order into the electronic medical record and then uses that order to justify the removal from the medication cabinet. Because of the lack of awareness of diversion and the tendency to trust our teammates, those fraudulent verbal orders can go unrecognized for quite some time. Here are a few guidelines to follow to help reduce the risk for diversion for verbal orders:
- In policies, place restrictions on verbal orders. Restrict verbal orders to emergency situations and monitor for compliance.
- Monitor and enforce the timely authentication of verbal orders by physicians.
- Educate the physicians on diversion and the need to confirm all controlled substance verbal orders were actually given by them and needed by the patient.
- Put a system in place to check in with the patients occasionally to see if medications “administered” have been effective, especially those orders through a verbal order.