Case
The patient was admitted to the hospital with wheezing, and the doctor verbally told the duty after the physical examination The nurse entered the patient with 5% glucose and added Chuanding intravenously, and the nurse performed it. Later, the patient’s family suddenly remembered that the patient had diabetes and did not tell the doctor that when it was found that the patient was infused with glucose, the patient’s family quit, saying that the infusion of glucose aggravated the condition. At this time, the doctor repented and refused to admit that the oral doctor’s order was given by him, and the nurse took the blame. The patient reported to the hospital, and the nurse was punished.
What is an oral doctor’s order?
Oral medical orders are medical orders that are not recorded in writing or that need to be recorded later. Because of the lack of necessary carriers, disputes and shirk responsibilities are likely to occur. Therefore, there are strict regulations on the application of oral medical orders. , that is, it must be used in rescue situations or during surgery, and oral doctor’s orders should not be executed under normal circumstances.
The “Doctor’s Order Check System” and “Rescue Work System” also have clear operational guidelines for the implementation of oral medical orders, such as ” Article 6 of the “Rescue Work System” clearly stipulates that the inspection system must be strictly implemented. Article 6 of the “Doctor’s Order Checking System” reads: “When rescuing a patient, the doctor issues an oral doctor’s order, and the executor must recite it again, and then execute it, and keep the used empty medicine bottle. Go.” Clearly tell the nurse that the verbal doctor’s orders cannot be followed in non-rescue situations.
Why are there so many oral doctor orders?
Doctors do not give oral medical orders, nurses do not carry out oral medical orders, doctors understand, and nurses understand, why do oral medical orders often appear in clinical work?
There are three reasons:
< span>1. Doctors and nurses have weak awareness of occupational risks.
2. Doctors are lazy on night shifts, unwilling to get up to give orders, and give oral orders after listening to the nurse’s report.
3. The patient was admitted to the hospital in an emergency, and the doctor issued an oral medical order for timely treatment, such as the case in this article.
reasons for a nurse to perform a verbal order
1, The doctor who gave the oral medical order was older or more dignified, and the nurse could neither refuse nor dare to refuse the oral medical order.
2. Doctors on mid-time or night shifts rest, doctors are lazy and unwilling to get up to check on patients, nurses are embarrassed to wake the doctor, and the doctor obeys the nurse’s report Verbal doctor’s order, the nurse executes the oral doctor’s order to maintain a good doctor-nurse relationship.
How to respond to oral doctor’s orders
1. Head nurse Regularly study the six core systems and related cases for nurses, cultivate the spirit of prudence and independence, strictly implement the doctor’s order checking system, and control the scope of application of oral doctor’s orders.
2. The chief nurse of the department conducts quality evaluations on a regular basis. The doctors who give oral medical orders and the nurses who carry out oral medical orders will be criticized in the morning meeting. In addition, certain performance penalties should be given.
3. The director of the department strengthens the ideological education of doctors, and should not be lazy on night shifts. The patient should go to the bedside to see the patient as soon as possible. The duty room listened to the nurse’s report and blindly issued oral doctor’s orders.
4. The Nursing Department convened a meeting of the head nurse, requiring the head nurse to communicate to each nurse and act in strict accordance with the rules. No oral doctor’s order shall be executed, and the oral doctor’s order shall be resolutely refused.
5. For newly admitted patients, the doctor issues an oral doctor’s order, and the nurse can call another nurse to confirm and then execute it.
Avoid the execution of oral doctor’s orders
Death Case 1
A patient went to a county hospital for metastatic right lower quadrant pain. He was admitted to the hospital for temporary intravenous infusion treatment with “appendicitis”. On the night of admission, the patient’s abdominal pain worsened. After the family informed the nurse on duty, the nurse called the doctor on duty. The doctor on duty instructed the nurse on the phone to inject 0.050 g of pethidine hydrochloride intramuscularly for the patient. The patient died 4 hours and 30 minutes later.
After the death of the patient, there was a dispute between the doctor and the patient. The autopsy report of the deceased showed that the cause of death was acute myocardial infarction. The medical malpractice is technically identified as a first-class medical malpractice, and the medical side shall bear the secondary responsibility. Medical institutions provide financial compensation to the families of the deceased. In the process of handling disputes, the doctor on duty that day did not admit that he had issued a doctor’s order at night.
Death Case II
A pregnant woman was Pregnant, admitted to a hospital, after going through the hospitalization procedures, due to the shortage of hospital beds, the hospital sent the mother to go home for delivery. At night two days later, the pregnant woman was admitted to the hospital because she felt abnormal fetal movement. The nurse on duty gave a physical examination and reported it to the doctor on duty. The doctor on duty verbally told the nurse to ask the pregnant woman to go home for delivery and come to the hospital the next day. The pregnant woman came to the hospital the next day and was found to be stillborn. In the end, the medical institution compensated nearly 150,000 yuan.
The above two cases both involved the issue and execution of oral doctor’s orders, and eventually the death of the patient or the fetus occurred. big. In the process of handling disputes, doctors and nurses have different opinions on whether or not to issue oral medical orders. Whether it is the external handling of doctor-patient disputes or the future work cooperation between doctors and nurses, it has caused great harm. troubles.
The following will discuss the standard use of oral wills, legal risks and precautions for medical care in actual clinical work, etc. The above two cases are analyzed in detail from multiple dimensions.
First, the concept of oral doctor’s order
< p>Oral doctor’s order refers to the fact that a doctor makes an oral doctor’s order when it is inconvenient to issue a written doctor’s order during rescue or surgery.issued medical order. According to this definition, the issuance and execution of oral medical orders are limited to rescue or surgery, and it is inconvenient to issue written medical orders at that time. Both conditions must be met at the same time.
II. Legal risks of irregular use of oral doctor’s orders
< /p>
The common irregularities of issuing oral doctor’s orders in clinical management usually occur at night or when the doctor on duty in the ward leaves the ward for attending emergency room, consultation in other departments or temporary surgery. When the nurse on duty finds that the patient’s condition has changed, report to the night shift doctor or call the outgoing doctor. In this case, after the doctor makes a preliminary judgment based on the situation reported by the nurse, most doctors will notify the attending doctor or go to the patient’s bed to check on the patient in person, and then issue a doctor’s order for the nurse to execute. Due to lack of awareness of the system, some doctors think that the nurses are making a big fuss, and they verbally issue medical orders to the nurses without examining the patients, or directly instruct the nurses to continue clinical observation.
According to the “Law of Practising Physicians”, “Nurse Regulations”, “Basic Norms for Writing Medical Records”, core medical care system and other laws and regulations, Physicians who carry out diagnosis and treatment and issue medical documents must conduct medical examinations in person. Nurses shall submit opinions to the doctor who issued the doctor’s order, and report to the hospital management department when necessary.
Any diagnosis and treatment received by a patient is derived from a doctor’s order, even if it is a correct and standardized doctor’s order, due to the limitations of medical science itself, and the severity of the disease. The complexity, individual differences of patients, and the risk of diagnosis and treatment measures may bring unforeseen iatrogenic damage to patients. The non-standard use of oral doctor’s orders has a greater risk, which is a neglect of patients’ life and health safety. If damage is caused to the patient due to violation of the above provisions, the medical institution and its medical staff shall bear civil compensation liability; if a medical accident is constituted, the health administrative department shall impose administrative penalties on the unit and individual; if the circumstances are serious, criminal responsibility shall be investigated according to law.
Third, words to clinical nurses
For a long time, nurses have always been in a relatively weak position in the work cooperation between doctors and nurses. They often dare not speak up or get a correct and timely response to the legal compliance review of doctors’ orders. . In the event of a dispute, since most of the management positions within the medical institution are also professional doctors, it is difficult for nurses to fight for their own interests in terms of internal accountability.
Based on the above reasons, clinical nurses dare to question authority in the cooperation of medical and nursing care, say “no” to the violations of small partners. ”, not only for the consideration of patient safety, but also for the need for self-protection. In the event of illegally issuing an oral medical order, if it cannot be corrected in time, the method of asking the doctor to write the oral medical order in the standby medical order book should be adopted to avoid legal risks. For those who neither issue a doctor’s order in person nor refuse to write a written doctor’s order, the doctor concerned can be asked to send it to the executive nurse in the form of a mobile phone text message, and the content of the text message should cover the patient’s information. Medical care is a family. We are partners and comrades in the face of disease. The basis of cooperation is mutual trust and mutual assistance, not love and killing.
In today’s world where medical science is so developed, all kinds of auxiliary medical equipment have provided great convenience for doctors and nurses. Convenience cannot replace the eyes and hands of medical staff. When doctors and nurses visit patients, they not only help patients with your professional skills, but also use your calm expressions, warm eyes, and kind touches to provide care and support to patients.
The above cases are real cases that happened in the hospital. In order to protect the privacy of the parties, the relevant information is hidden.
Source: Nurse’s official micro, network
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