Every phone order in a long-term care facility creates extra work. A nurse takes the call, writes down the details, reads them back, enters them into the record and later follows up for the provider's signature. Each step is a chance for a misheard drug name, a missing dose, a duplicate entry or a delay. Multiply that by dozens of orders a week, and the time and risk add up.
Phone orders cannot disappear entirely, since emergencies and some on-call situations require them. But most facilities can reduce them and make the remaining ones safer. This post describes practical ways to streamline how provider orders reach the record. It applies to facilities using PointClickCare and to others, and it describes workflows in general terms. Check with your vendor or system administrator about the specific tools available in your setup.
Orders drive nearly everything else: medications, treatments, labs, diet, therapy and monitoring. If the order is wrong or late, the rest of the chain follows. Rework, such as clarification calls, corrected entries and discontinued duplicate orders, takes nursing time away from residents and frustrates providers.
Before changing anything, learn how orders move today. Pick a week and track:
How many orders arrive by phone, fax, electronic message or in-person visit
Who receives them and who enters them
How long it takes from the provider's decision to an active order
How many need clarification or correction
How long it takes to collect signatures
Talk to nurses about the pain points. They know where the process gets stuck.
Where your system allows providers to enter orders electronically, work with them to adopt it. This removes transcription entirely. Providers are more likely to participate if setup is simple, if they get training and if the process fits how they work.
Many phone orders stem from unscheduled calls during busy times. Predictable provider rounds, structured visit notes and a set time for nurses to review non-urgent issues can reduce interruptions.
A structured way of communicating helps both sides. Before calling, a nurse should gather the resident's current condition, vital signs, recent changes, medication list and allergies. Using a simple standard format keeps calls short and orders clear.
Work with your medical director to develop order sets or preferred wording for common situations, such as admission orders or routine labs. Standard options reduce free-text and mistakes.
Read back and verify. The nurse repeats the order, including the drug name spelled out, dose, route and frequency, and the provider confirms.
Use only authorized staff. Define who may take orders under your policies and state requirements.
Enter promptly. Do not let handwritten notes pile up. Enter orders as soon as possible.
Document the source. Record who gave the order and when.
Track signatures. Have a routine for getting verbal and telephone orders countersigned within the time frames required by your policies and regulations.
Designate someone, such as a unit manager, to review new orders each day to catch errors, duplicates and conflicts. Reviewing orders against the original note or message catches transcription problems early.
If certain providers or order types lead to repeated clarification, ask why. The issue may be a poorly designed form, a confusing option in the system or a need for training.
Old orders left active create confusion. Schedule routine cleanup, and make discontinuation part of the process whenever a new order replaces an old one.
Make sure new medication orders reach the pharmacy quickly and clearly. Use a consistent process and confirm receipt for urgent medications.
Pick two or three simple measures and track them monthly:
The share of orders that come by phone
Orders needing correction or clarification
Time to obtain signatures
Share results with nurses and providers and celebrate improvement.
An order workflow only works if devices are available, wireless coverage is solid, sign-in is quick and secure remote access works for providers who are off-site. UnityCare IT helps long-term care organizations address those foundations, so the people who write orders and the people who enter them are not slowed by technology.
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