84-05 Privileges for giving orders.
(A) Definition of "patient orders."
A patient order(s) is a prescription for care or treatment of patients. An order can be given verbally, electronically or in writing to qualified personnel identified by category in paragraph (C) of this rule, and shall be authenticated by the licensed medical practitioner. Patient orders may be given initially, renewed, discontinued or cancelled. Throughout these rules and regulations, the word "written" and its grammatical derivatives, as used to describe a non-verbal order, refer to both written and electronically entered orders.
(B) Electronic ordering.
Electronic orders are equivalent and have the same force as written orders. Electronic orders have been expressly structured to mirror these rules and regulations and all policy guidelines adopted by the medical staff and hospital administration.
(C) Responsible medical practitioner.
The licensed physician, dentist, podiatrist, or psychologist (under medical doctor supervision) member of the medical staff responsible for the care and treatment of the patient is responsible for all orders for the patient. Attending and courtesy medical staff may designate members of the limited staff, or other licensed healthcare professional with appropriate clinical privileges to write or electronically enter orders under their direction. The attending staff member may also designate members of the pre-M.D. medical student group to write or electronically enter orders, but in all cases these orders shall be signed by the physician, dentist, podiatrist, psychologist, or designated limited staff member who has the right of practice of medicine, dentistry, psychology, or podiatry, and who is responsible for that patient's care. All non-verbal orders must be authenticated by the medical practitioner prior to the execution of the order(s) by the hospital or outpatient nursing staff or other professional groups.
(D) Telephone and verbal orders.
Telephone and verbal orders may be given by the responsible attending physician, dentist, podiatrist, psychologist, member of the limited staff, or other licensed healthcare professional with appropriate clinical privileges only to health care providers who have been approved in writing by title or category by the medical director and each chief of the clinical service where they shall exercise clinical privileges, and only where said health care provider is exercising responsibilities which have been approved and delineated by job description for employees of the hospitals, or by the customary medical staff credentialing process when the provider is not an employee of the hospitals. Lists of the approved titles or categories of providers shall be maintained by the chief medical officer. Verbal orders should be utilized infrequently. The individual giving the verbal or telephone order must verify the complete order by having the person receiving the information record and "read back" the complete order to assure the quality and safety of patient care. The job description or delineated privileges for each provider must indicate each provider's authority to receive telephone or verbal orders, including but not limited to the authority to receive orders for medications. The order is to be recorded and authenticated by the approved health care provider to whom it is given as "verbal order by," or "V. O. or T. O. by," recording the licensed healthcare practitioner's name and the time of the order. All verbal orders for D.E.A. schedule II controlled substances, patient seclusion, or patient restraint must be authenticated within twenty-four hours by signature of a licensed physician, dentist, podiatrist, psychologist, or designated limited staff member, or other licensed healthcare professional with appropriate clinical privileges. Verbal orders for directives of urgent issues that cannot be addressed by the prescriber's order entry are encouraged to be signed electronically within forty-eight hours, but must be authenticated within twenty-one days by a licensed physician, dentist, podiatrist, psychologist, limited staff member, or other licensed healthcare professional with appropriate privileges.
(E) Standing orders.
Standing orders for medications are only approved in emergency situations. All other standing orders must developed, approved, used and monitored in strict compliance with the standing orders medical staff policy approved by the medical staff administrative committee and hospital administration.
(F) Preprinted orders.
Preprinted order forms for patients must be reviewed, dated, timed and signed by a responsible medical practitioner, a limited staff member, or other licensed healthcare professional with appropriate privileges before becoming effective.
(G) Investigational drug orders.
Evidence of informed patient consent must be available to a nurse or pharmacist before an investigational agent is ordered and administered. Investigational drugs may be ordered only upon authorization of the principal or co-investigator or other delegated physician, dentist, psychologist, or podiatrist named in FDA forms 1572 or 1573. Registered nurses or pharmacists who are knowledgeable about the investigational agents may administer the drugs to patients.
(H) Change of nursing service.
"Change of nursing service" means official and physical movement (transfer) of a patient from any permanent care unit to another with or without change in attending physician, dentist, psychologist, or podiatrist or clinical service. Orders effective before transfer must be reviewed, renewed, rewritten or reentered upon transfer by the responsible medical practitioner. The new or renewed orders may be written or electronically entered before or when the patient arrives on the receiving unit and may become effective immediately.
In each case of "change of nursing service," it is the responsibility of the receiving nurse to establish the availability of renewed or new written or electronically entered orders. Prior orders shall remain in effect until new orders are available. This should be done within eight hours of transfer.
(I) Transfer of clinical service.
Transfer of clinical service means transfer of full patient responsibility from one attending physician, dentist, psychologist, or podiatrist to another; the patient may remain on the same unit or a "change of nursing service" may also occur. Admission of a patient from an emergency service to the hospital as an inpatient involves "transfer of clinical service."
For the purposes of writing or electronically entering orders, two essentials of "transfer of clinical service" are necessary:
(1) The initial transfer order must indicate the release of responsibility and control of the patient, pending acceptance by the receiving service. The order may read "transfer (or admit) to Dr., thoracic surgery service."
(2) Transfer of service may be completed only by the receiving service writing or electronically entering an order to the effect "accept in transfer (or admission) to Dr., cardiology service."
Orders effective before the transfer must be renewed, rewritten or reentered upon transfer by the responsible medical practitioner, a limited staff member, or other licensed healthcare professional with appropriate privileges. The new or renewed orders may be written or electronically entered before or at the time of transfer, and may become effective immediately. It is the responsibility of the receiving nurse to establish the availability of new or renewed orders. If new orders are unavailable, then the nurse may continue previous orders and immediately notify the responsible medical practitioner.
(J) Patient orders and the "covering" medical practitioner.
"Coverage" of patient responsibilities for another physician, dentist, psychologist, or podiatrist for a brief period of time does not constitute or require "transfer of clinical service" unless so desired and agreed upon by the physician, dentist, psychologist, or podiatrist and patient.
(K) Hospital discharge/readmission orders.
Hospital discharge from standard inpatient units or day care units to outpatient status requires appropriate discharge orders. Readmission to any inpatient unit requires new, rewritten/reentered or renewed orders by the responsible medical practitioner, a limited staff member, or other licensed healthcare professional with appropriate privileges.
(L) Orders in emergency vehicles.
These rules and regulations apply to university hospital's owned and/or manned emergency care and retrieval vehicles.
(M) Do not resuscitate order.
Do not resuscitate orders must be written or electronically entered in strict compliance with the comprehensive policy guidelines published by the medical staff administrative committee and hospital administration. See hospital policy 03-24.
(N) Hospital admission/observation orders.
Hospital admission/observation requires an appropriate level of care (ALOC) designating the patient as an inpatient or an outpatient (observation). The appropriate level of care (ALOC) order may be written and signed by the attending physician. If the ALOC order for inpatient admission is written by a member of the limited staff or other licensed healthcare practitioner with appropriate clinical privileges, it must be co-signed by the attending physician prior to the patient being discharged from the hospital. Admission to any inpatient unit or placing a patient in observation status requires new, rewritten/reentered or renewed orders by the responsible physician, limited staff member or other licensed healthcare practitioner with appropriate clinical privileges and under the supervision of the collaborating physician.
(Board approval dates: 9/6/2002, 6/4/2004, 5/6/2005, 11/4/2005, 2/2/2007, 6/6/2008, 9/18/2009 4/8/2011, 4/6/2016, 9/2/2016)