# A nurse is taking a verbal medication order during a code blue from the resident physician at the bedside. The resident says, Give 2 of epi. Which actions are required for safe verbal order processing per Joint Commission standards? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368265&lang=en  
> language: en  
> subject: Collaboration with Multidisciplinary Team  
> category: MOC

## Question

A nurse is taking a verbal medication order during a code blue from the resident physician at the bedside. The resident says, Give 2 of epi. Which actions are required for safe verbal order processing per Joint Commission standards? Select all that apply.

1

Clarify the ambiguous order by asking, Is that 2 mg of epinephrine 1:10,000 IV push, before drawing the medication

2

Refrain from clarifying the order with the resident to maintain team rapport and avoid delaying life-saving interventions during a code

3

Administer epinephrine immediately using standard ACLS dosing, then clarify the exact order and complete documentation after the code

4

Accept the abbreviation 'epi' as part of the verbal order during the emergency, since using full terminology would delay urgent treatment

5

Document the verbal order in the medical record within the timeframe required by facility policy and ensure prescriber co-signature within 48 hours

6

Repeat back the complete order including drug name, dose with units, route, and frequency before administering

## Explanation

Verbal and telephone orders are a high-error setting and Joint Commission requires specific safeguards. Required actions: (1) read-back: the nurse repeats the complete order (drug, dose with units, route, frequency) and the prescriber confirms — a National Patient Safety Goal; (2) clarification of ambiguous orders (2 of epi could be 2 mg or 2 mL of various concentrations) using full drug names and doses with units before drug preparation; (4) documentation in the EHR within the facility timeframe (typically immediate or within 1 hour) with prescriber co-signature within facility policy (commonly 24 to 48 hours). Administering before clarification (option 3) violates safe medication administration. Accepting abbreviations (option 4) causes errors — epi could be epinephrine or ephedrine. Failing to clarify (option 2) violates the nurse duty to question unclear orders; respectful clarification protects the patient.

## In-depth explanation

Verbal Order Safety — TJC Standards
Three required practices: read-back, clarification, documentation.

Read-Back Format
Nurse: Confirming order for (drug name spelled out) (dose with units) (route) (frequency). Is that correct?
Prescriber: Confirmed.

Clarification Required When
- Abbreviations (epi, morph, tylenol)
- Concentration ambiguity (multiple strengths exist)
- Missing units (2 of x)
- Look-alike or sound-alike drugs

Documentation
- EHR entry within facility timeframe
- Prescriber co-signature within 24 to 48 hours
- Read-back confirmation noted

Wrong Answers
3: Administering before clarifying is unsafe.
5: Abbreviations cause sound-alike errors.
6: Nurse duty includes questioning unclear orders.

NCSBN Theme
MOC — Collaboration and safe medication administration.

## Clinical scenario

Scenario
Code blue, nurse receives verbal order from resident at bedside.

Order Given
Resident: Give 2 of epi

Ambiguities
- epi could be epinephrine or ephedrine
- 2 could be 2 mg or 2 mL
- Concentration not stated (1:10,000 vs 1:1,000)
- Route not stated (IV push or IM)

Required Response
Read-back plus clarify plus document.

## Key concepts

- **Verbal or telephone order** — An order communicated by spoken word rather than written or electronically entered. Permitted when in-person or electronic entry is impractical (emergencies, sterile field). Joint Commission requires: (1) read-back of complete order with drug spelled when needed, dose with units, route, frequency; (2) prescriber verbal confirmation; (3) immediate EHR documentation; (4) prescriber co-signature within the facility-defined timeframe (commonly 24 to 48 hours).
- **Read-back protocol** — A National Patient Safety Goal practice — the receiver of a verbal order or critical lab value repeats the information back to the sender, who confirms or corrects. Captures mishearing, look-alike or sound-alike confusions, and dose unit errors before harm. Must be documented in the medical record.
- **Order clarification duty** — The nurse professional and legal obligation to seek clarification of ambiguous, unsafe, or contraindicated orders before execution. Includes questioning the prescriber, consulting the pharmacist, or escalating up the chain of command. Documentation of the clarification protects the nurse and the patient. Refusal to clarify can constitute failure to advocate.

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