Introduction
Quality health care is the primary goal of any health institution, and it highlights patient safety as the chief principle. Quality patient care implies avoiding errors, learning from the mistakes made, and applying safety practices to deliver proper care. It is necessary to state that several factors condition the quality of service, but the major one is connected to the effectiveness of verbal orders. Such orders should provide efficient communication between staff members of the clinic to reach consensus and increase their integrity. Verbal requests came to use a long time ago; therefore, it is the most common method of interacting in nursing homes, hospitals, and clinics.
However, sometimes one order can cause a medication error if a staff member accidentally makes a mistake in perceiving it. The purpose of this paper is the investigate the nature of the verbal orders and medication errors and to find out whether there are any recommendations for eliminating these issues.
Verbal Orders and their Impact
Every health institution is supplied by the system of verbal orders (VOs) as it is a means of convenience and claims its goal a patient safety. However, the use of verbal requests proves to cause more mediocre care delivery because the information the hospital staff receives can be misheard, misinterpreted, or disregarded. Typically, a nurse in a registry, licensed nurse, or therapist, accepts verbal orders when the authorized staff member cannot do this (Moghaddasi et al., 2017).
Oral requests may be given through face-to-face conversation, telephone, or any other transmission device to alleviate the communication, so any data concerning a patient can be received promptly. Compiling a medical order is a complex process that includes analyzing the symptoms of a disease, the results of some tests and examinations, the patient’s desires, benefits, and risks. Nevertheless, there can be problems when one composes the order based on the inadequate evaluation of symptoms, treatment application, and threats.
VOs are used when the prescriber is unable or unwilling to carry out such a procedure, so the use of the orders may be seen as appropriate and inappropriate. For instance, face-to-face orders may be demanded when a prescriber is having a healing session with a client so that the doctor cannot interrupt the course to write a verbal request. However, face-to-face orders can come into routine usage so that the health care workers will not have to use electronic systems for inserting verbal orders.
The telephone VOs are also necessary when the patient or a doctor cannot be present in a hospital. The appropriate use of such orders includes non-serious health cases, patient rounds, team appointments (Moghaddasi et al., 2017). There are cases when the implementation of verbal requests is improper; such cases usually deal with severe physical and mental illnesses’ treatments.
Medical orders have implications ranging from health-improving to life-threatening. The reasons why VOs because dramatic consequences are the following: misspeaking, mishearing sound-alike drugs, dose, and frequency, transcription errors, confusing patients’ data, muffled voices, accents (Moghaddasi et al., 2017). It should be noted that such cases may jeopardize one’s life. Therefore, the lack of practical research does not allow for the establishment of precise numbers of the variables cause by verbal orders.
As a result, some recommendations were suggested to avoid verbal orders in further medical practice. First and foremost, chemotherapy medications were prohibited except for holding or discontinuing them. “These medications are not administered in emergent situations, and the dosing regimens are often complex” (Shastay, 2019, p. 231). Another guidance suggested is aimed towards limiting verbal orders to emergencies when the prescriber is incapable of transmitting orders electronically. Another limitation imposed implies restricting formulary drugs. “If verbal orders are necessary, only allow them for items on formulary because the names and dosages of medicines unfamiliar to practitioners are more likely to be misheard” (Shastay, 2019, p. 232).
Defining the process is also crucial as it establishes prohibitions and limitations concerning the acceptability of the medical orders, the authority of the prescriber, and elements of the order. Nonetheless, communication represents a significant point, too, as it allows clarifying information about the drugs prescribed: precise dosage, frequency, route, or abbreviation. In general, the prescriber must speak clearly, provide complete orders, discourage misuse, avoid abbreviations, request patient’s verification, and make sure the order given is adequate.
Moreover, sometimes the nurses or physicians are not aware that the process of verbal order verification takes a while. Some researchers stated that the engagement of the health care workers into training sessions concerning the documentation is beneficial (Moghaddasi et al., 2017). Another approach is implementing computerized physician order entry and mobile-based devices to provide accuracy and access to all the patients’ data (Moghaddasi et al., 2017).
Therefore, eluding verbal order errors may be electronically conditioned or paper-based. The chief role in establishing an adequate system of verbal orders belongs to the hospital or nursing administration who could store and correct necessary data. Verbal requests are the primary mechanism of communication within the healthcare system. The neglect of them can cause medication errors, thus endangering patients’ safety and causing threats to their health.
Medication Errors and their Impact
As was mentioned, the inappropriate use of verbal orders may well lead to medication errors that concern the improper taking of medications prescribed by a health professional or the organization that may harm people. There are different approaches to defining medication errors. “One approach is to base the classification on the stage in the sequence of medication use processes, such as prescribing, transcribing, dispensing, administration, or monitoring” (World Health Organization, 2016, p. 4). Another approach views the errors according to the type of medication, patient, route, dose, or frequency. The last kind of mistake is based on the level of severity (World Health Organization, 2016). Though, there is not enough valid evidence to prove the efficacy of each approach towards identifying one or another error.
Medication errors tend to occur more often these days due to specific reasons. Several studies determined the following factors concerning the health care professionals: lack of therapeutic skills, inadequate drug knowledge, lack of patient’s data knowledge, fatigued healthcare workers, physical and mental health problems, inconsistent or poor communication between the doctor and patient (World Health Organization, 2016). The next group of causes affecting errors relates to the patients. Such include the complexity of a person, which implies language barrier, personal streaks, their beliefs, etc., and the level of the case complexity, which denotes multiple health conditions.
Moreover, the complications can be the cause of the work environment: interruptions, distractions, time pressures, or insufficient resources affect the staff (World Health Organization, 2016). The rest of the reasons that impact the appearance of errors may depend on the medicine and its name, accuracy of patient data in the computerized database, or complicated processes in the computer program.
Reducing medication errors is necessary to provide high-quality patient safety. Though the potential solutions were identified, there is still a need for a sophisticated approach towards resolving this issue. First of all, researchers stated the necessity of conducting a medication review to improve health outcomes and alleviate drug-related events (World Health Organization, 2016). Such examinations must be carried out by pharmacists or clinicians dealing with chemical remedies. What is more, medical reconciliation is a key to reducing errors. “Medication reconciliation is the formal process of establishing and documenting a consistent, definitive list of medicines across transitions of care and then rectifying any discrepancies” (World Health Organization, 2016, p. 9).
Another resolution is aimed towards automated information systems that comprise all the patient-related data, which let prevent the occurrence of serious errors. Educating the health organization staff should be the primary goal of ensuring patient safety. Undoubtedly, multicomponent interventions, both practical and theoretical, must be carried out to avert medication errors. However, there is not enough research in this area to provide efficient patient care devoid of blunders.
Conclusion
To sum everything up, it is necessary to restate that verbal orders and medication errors are interconnected, which means one issue leads to another. Both problems raised cause significant consequences affecting patient safety and quality care delivery. Thus, there are specific recommendations mainly concerning improving health care members’ education, strengthening the use of electronic devices, computerizing patients’ data, and focusing on creating a better patient safety culture. More practical and empirical research should be conducted within this area to improve the entire system.
References
World Health Organization. (2016). Medication errors: Technical series on safer primary care. World Health Organization.
Moghaddasi, H., Farahbakhsh, M., & Zehtab, H. (2017). Verbal orders in medicine: Challenges; problems and solutions. JOJ Nursing & Health Care, 1(5), 1-6.
Shastay, A. (2019). Despite technology, verbal orders persist, read back is not widespread, and errors continue. Home Healthcare Now, 37(4), 230-233.