Reducing Errors Associated with Verbal Orders

Medication orders that are communicated verbally offer unique opportunities for errors to occur. Verbal orders are defined as prescriptions or medication orders that are communicated as oral, spoken communications between senders and receivers—face to face, by telephone or by other auditory device. The National Coordinating Council for Medication Error and Prevention has developed a set of recommendations specifically intended to address the risks of verbal orders:

• Verbal communication of prescriptions or medication orders should be limited to urgent situations where immediate written or electronic communication is not feasible.
• Healthcare organizations should establish policies and procedures that:
• Describe limitations or prohibitions on use of verbal orders
• Provide a mechanism to ensure the prescriber’s validity or authenticity
• List the elements that must be included in a complete verbal order
• Describe situations in which verbal orders may be used
• List and define the individuals who may send and receive verbal orders
• Provide guidelines for clear and effective communication of verbal orders.

• Pharmacists should encourage staff to question prescribers when there are any concerns or disagreements about verbal orders. Questions about verbal orders should be resolved before preparing, dispensing or administering the medication.
• A verbal order should include:
• Patient’s name
• Patient’s age and weight, when appropriate
• Drug name
• Dosage form (for example, tablets, capsules, inhalants)
• Exact strength or concentration
• Dose, frequency and route of administration
• Quantity and/or duration of treatment
• Purpose or indication (unless the prescriber considers disclosure inappropriate)
• Specific instructions for use
• Prescriber’s name and telephone number when appropriate
• Name of individual transmitting the order, if different from the prescriber.
• The name of the drug should be confirmed by any of the following:
• Spelling
• Providing both the brand and the generic names of the medication
• Providing the indication for use.
• To avoid confusion with spoken numbers, a dose such as 50 mg should be dictated as "fifty milligrams...five zero milligrams" to distinguish from "fifteen milligrams...one five milligrams."
• Instructions for use should avoid abbreviations. For example, "1tab tid" should be communicated as "Take/give one tablet three times daily."
• The entire verbal order should be repeated back to the prescriber or the individual transmitting the order, using the principles outlined in these recommendations.
• All verbal orders should be written down immediately and signed by the individual receiving the order.
• Verbal orders should be documented in the patient’s medical record, then reviewed and countersigned by the prescriber as soon as possible.