Question: We are reviewing and revising our Hospital’s Medical Staff Rules and Regulations and were concerned about medical staff members’ compliance with the section that requires all verbal orders to be authenticated by the ordering practitioner within 48 hours of the order being given.  Can we revise this requirement to give the ordering practitioner more time to authenticate the verbal order?

Answer:

It depends.  The Centers for Medicare & Medicaid Services (“CMS”) revised the Hospital Conditions of Participation (“CoPs”) in 2012.  The revised CoPs now permit verbal orders to be dated, timed and authenticated by the prescribing practitioner or another practitioner responsible for the care of the patient and who is authorized by hospital policy in accordance with state law to write a specific order (even if the order did not originate with him or her).  Thus, the 48-hour time frame for authentication has been removed and CMS is now deferring to state law and hospital policy.  Nonetheless, CMS continues to emphasize that hospitals should “keep the use of such orders to a minimum” and have policies in place to ensure accuracy, such as requirements for “read-back and verify.”  In addition, some states have their own time requirements for the authentication of verbal orders.  So, even though CMS has eliminated the 48?hour requirement for authentication of verbal orders, you will have to consult your state law and regulations before revising your Medical Staff Rules and Regulations.

Even if your state does not have a time requirement for the authentication of verbal orders, there are policy reasons underlying time requirements for authentication of verbal orders.  Verbal orders are prone to errors because of the risk of the practitioner accepting the order mishearing the order that is given.  While much of this risk is minimized by keeping the use of verbal orders to a minimum and with read-back and verify requirements, time-limited authentication requirements serve to identify and correct errors in a short period of time.  Accordingly, a 48?hour authentication requirement helps to further minimize the risk of errors with verbal orders.

Lastly, if there are concerns about the medical staff complying with a 48-hour requirement for authentication, CMS now, explicitly, allows not only the ordering practitioner but also other practitioners caring for the patient and acting within their scope of practice to authenticate verbal orders.  Thus, if a verbal order is given on a Friday night, the physician giving the verbal order would not have to come into the hospital by Sunday night to authenticate the verbal order if the Rules and Regulations include a 48-hour authentication requirement.  Another practitioner caring for the patient could authenticate the order.  However, and once again, you will have to consult state law and regulations to confirm that those sources impose no barriers to this practice.