Writing Orders

July 2, 2003

Dr. Karl

For housestaff, writing orders is an integral part of the daily routine. Properly written orders have been shown to improve both clinical outcomes and professional satisfaction! On the other hand, incorrectly written orders are a frequent and avoidable cause of patient morbidity.

This issue, Q Fever!’s I&R correspondent, Dr. Karl Newman, discusses his battle-tested rules of: Writing Orders .

Word up! It's been a heckuva month, and all I can say is: no matter what they're payin', do not participate in a study that involves having radioactive seeds implanted in your prostate. Yowza!

So ya don't wanna waste any time getting started with today's topic - I hear ya! Today we'll be reviewing the basics of order-writing. See, they teach you a lot of stuff in med school - dissecting frogs, stoichiometry, and the like - but how much of it do you really wind up using as a doctor? I can't even remember the last time I needed to do a frog dissection on the wards. No, wait. Bad example.

But my point is, they never taught you how to: write an order.

So you know what happens? Total chaos. People running around without a clue as to what's going on. Security getting paged stat. And that's just in the parking lot, cuz' you lost your swipe card and drove through the wooden swing bar again.

But as my grandma Bubbie always tells me: Stick with me, young lass - I won't do you no wrong. So here's the rules ya gotta play by:

1) Them ORDERS Gotta Have BORDERS

Think of it this way: Sure, an order is your ultimate tool for getting things done. But that doesn't mean you can order anything you want. You gotta show some restraint, even when you're ordering restraints! Yeah, it takes some time, but eventually you gotta learn what's appropriate and what's not. Ordering yourself a ham sandwich with mustard and mayo is appropriate. Ordering it with ketchup is not.

Other things that are are usually inappropriate to order:
• Having the nurse page you out of conference
• Having the clerk check the lights on your SUV
• Getting escort to take you to the airport
• Having physical therapy give you a full frontal massage
• Having physical therapy escort your SUV to the airport for a full frontal massage

Also, remember that most orders can be placed online these days! You'll save big on sales tax, but watch for those hidden shipping charges. Just another Helpful HintT from Dr. Karl!

2) Don't Be Sloppy, Joe!

Accuracy in writing orders is crucial. It's a cliché, but most doctors these days really do have atrocious handwriting. You know why? Yep, you guessed right! Most doctors these days are in fact descendants of the ancient Egyptians, who had a culture where penmanship was taught only to priests and select scribes. It's true! Look it up.

But that doesn't mean it's hopeless. On the contrary, you'll make a big impression if you can neatly print out your orders in block or cursive lettering. Better yet, do what I do: carry around a small rubber stamp kit, with one stamp for each letter of the alphabet. It can get a little bulky, but it'll be worth it when you see those smiles as you approach the nurse's station!

Another way to increase accuracy is to avoid the use of verbal orders. These can be easily misinterpreted, and by the time discrepancies are discovered, the harm's been done. Instead, use non-verbal orders - gesticulating wildly with your arms and head, for example, or making thrusty-type movements with your hips. These are much more likely to get the message you want across to nurses and concerned bystanders.

And one important thing that's often overlooked when it comes to good order-writing etiquette: Always make sure your medical student spells your name correctly when he/she forges your signature. Can't emphasize this one enough!

3) Da "i's" have it

Ever notice that a 5 looks a lot like an S? Or how a 3 looks like a backwards E? These look-a-likes are confusing, and are a leading cause of errors.

That's why you should always use write numbers using the "i" shorthand. For example, "two tablets by mouth twice a day" becomes "ii tabs po bid." ... "0.05 mg once a day" becomes "0.0iiiii mg qd" ... "100 mg four times a day" oughta be "iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii mg qid" ... and "20,000 units subcutaneously once a week" becomes ... well, you get the idea.

Using the "i" method will save you time and make your life easier! For the sake of completeness, be sure to use it to time and date your orders, too. June 4th, 2003? Try iiiiii/iiii/ii00iii. See what I mean?

Whooaaaa! Looks like it's time to wrap up another one. Page me if you wanna chat - I'm gonna go renew some morphine up on iiiii North. Meanwhile, 'till next issue ...

“Just tell ‘em Dr. Karl sent ya!”

Remember: Quality Without The Q Is Just Uality!