The night-shift nurse receives a telephone order from the on-call provider for "morphine 4 milligrams IV every 2 hours as needed for pain." Which action by the nurse demonstrates correct closed-loop communication?
1Ask the charge nurse to pick up a second line and listen to the call to verify the order, then enter the order into the EHR as heard, without reading it back to the provider for confirmation.
2Repeat the order back verbatim to the provider for confirmation: "morphine four milligrams IV every two hours as needed for pain — please confirm." Wait for confirmation before entering and administering.✓ Correct answer
3Document the telephone order as 'morphine 4 mg IV q2h prn pain' in the electronic health record after the call, then give the next dose when the patient requests it, because the order is clear.
4Inform the on-call provider that telephone orders are discouraged on the night shift per facility policy and request that they write the order in person during morning rounds.
Explanation
Option 2 is correct because closed-loop communication requires the nurse to repeat the complete telephone order, including the dose and interval, and obtain the provider's confirmation before entering and administering it. Option 1 is incorrect because a second nurse listening does not replace read-back to the prescriber. Option 3 is incorrect because documenting and administering the order without provider confirmation leaves a misheard order uncorrected. Option 4 is incorrect because telephone orders may be accepted when permitted by policy and verified through read-back; delaying a needed order until morning is not appropriate.
The closed-loop communication standard is RECEIVE → WRITE → READ-BACK → CONFIRM. Numbers should be spoken in full ("one zero" instead of "ten") to prevent mistakes. Some hospitals also require entering the order in the EHR for the provider to electronically sign within 24 hours.
Night shift, post-op patient with pain. The on-call provider gives a telephone order for morphine. The unit policy and Joint Commission National Patient Safety Goal require read-back verification of every verbal/telephone order.
Closed-loop communication — Receive → write → read-back → confirm before acting on a verbal/telephone order.
Joint Commission NPSG — National Patient Safety Goal requires read-back verification of all verbal/telephone orders.
Number-by-number readback — Speak each digit aloud (for example "four zero" instead of "forty") to prevent mishearing.