A verbal order (VO) is an instruction for patient care, such as a medication or treatment, that a Licensed Independent Practitioner (LIP) communicates orally to a qualified healthcare professional, typically a nurse. These orders are high-risk because they bypass the safety checks built into written or electronic systems, making them prone to errors from mishearing or misinterpretation. Strict adherence to established protocols is required to maintain accuracy and ensure regulatory compliance. Proper transcription and verification of a verbal order is a mandatory component of safe medical practice.
Context and Permissible Use
Verbal orders are not intended for routine use and should only be employed when obtaining a written or electronic order is impractical. The primary justification for a verbal order is an urgent situation requiring immediate action to avoid patient harm, such as during a life-threatening emergency. They are also accepted when a prescriber is engaged in a sterile procedure, like surgery, and cannot physically enter the order themselves.
Many institutions, including The Joint Commission (TJC), strongly discourage the use of verbal orders outside of these emergency or procedural contexts. Certain high-risk medications are strictly prohibited from being ordered verbally, such as chemotherapy or blood products, due to the potential for severe patient harm. Organizational policy sets clear boundaries on when a verbal order is acceptable and which treatments are excluded. If the prescriber is present and able to use the electronic health record (EHR) or write the order, a verbal order must not be accepted.
The Step-by-Step Transcription Process
The process begins immediately with the healthcare professional receiving the order, who must simultaneously write down or enter the order directly into the patient’s medical record. This immediate transcription prevents memory lapses and errors. The documentation must clearly indicate that the order was received verbally, often noted with the initials “VO” or “TO” (telephone order) next to the entry.
The documentation must contain all mandatory elements present in a written order. This includes:
- The exact date and time the order was received.
- The patient’s full name and at least one additional patient identifier.
- The complete drug name.
- The precise dose and unit of measure.
- The route of administration.
- The frequency.
To prevent confusion between sound-alike medications or misinterpreted numbers, the recipient should ask the prescriber to spell out unfamiliar drug names. Numerical digits should be enunciated separately—for example, saying “one five” for 15, rather than “fifteen.” The full name of the prescribing practitioner must be included, along with the receiving professional’s signature, initials, and title. Any ambiguity, such as an unapproved abbreviation or unclear dosing instruction, must be clarified with the prescriber before transcription is complete.
Mandatory Verification and Read-Back
Immediately after the order has been transcribed, a mandatory safety procedure known as the “Read-Back” must be performed to confirm accuracy. This step minimizes the risk of errors caused by poor acoustics or sound-alike words. The authorized recipient must read the entire order back to the prescriber exactly as it has been written or entered into the chart.
The read-back must be a verbatim recitation of the transcribed information, including the patient’s name and the full order details. The prescriber must listen carefully and confirm that the order is correct. If any part is incorrect, the process must be repeated until the prescriber verifies the accuracy. This verification is then documented in the patient’s record, typically with a notation such as “Read-Back Verified” or “RB,” before the order is implemented.
Required Post-Transcription Follow-Up
The final step involves the prescribing practitioner’s co-signature, or authentication, of the transcribed entry. This is a legal and regulatory requirement that validates the order as if it had been written by the prescriber initially. Most policies require the practitioner to review and sign the order within a specific time frame, commonly 24 or 48 hours from when the order was given.
The professional who received the order must track it and ensure authentication occurs within the designated period. If the time limit is approaching, they must proactively prompt the practitioner for their co-signature or notify a supervisor. An order remaining unsigned past the deadline is considered incomplete, which can create compliance issues during an audit. This final signature completes the legal record and confirms the practitioner’s acceptance of the transcribed order.