Verbal Prescriptions: Best Practices for Clarity and Safety in Healthcare

Every year, hundreds of patients in hospitals across Australia and the U.S. are harmed because someone misheard a medication order. Not because the doctor made a mistake - but because the way the order was spoken didn’t follow basic safety rules. Verbal prescriptions aren’t going away. They’re still needed in emergencies, during surgery, or when the EHR is down. But if you’re not following clear, proven steps to communicate them, you’re putting lives at risk.

Why Verbal Prescriptions Are Still Necessary

You can’t always type an order into a computer. Surgeons in the operating room can’t stop to click through menus. Nurses in the ER need antibiotics given five minutes ago, not five minutes from now. In these moments, saying the order out loud is the fastest - and sometimes only - way to get the right drug to the right patient.

But here’s the problem: verbal orders are messy. Studies show error rates between 30% and 50% when no safety steps are used. That’s not a small risk. That’s one in every two or three orders being wrong. And the consequences? Wrong dose. Wrong drug. Wrong patient. Sometimes, death.

The good news? You can cut those errors in half - even without a computer. It’s not about technology. It’s about how you talk.

The One Rule That Saves Lives: Read-Back Verification

The most powerful tool you have isn’t a tablet or a voice assistant. It’s your mouth - and your ears.

Read-back verification means the person receiving the order repeats it back, word for word, before acting on it. Not just the drug name. Not just the dose. The whole thing: patient name, medication, strength, route, frequency, reason, and who ordered it.

This isn’t optional. The Joint Commission made it mandatory in 2006. Medicare requires it. And every major hospital in Australia and the U.S. has it in their policy.

Here’s how it works in real life:

• Doctor: “Give 500 milligrams of vancomycin IV over 60 minutes for MRSA infection.”
• Nurse: “Confirming: 500 milligrams of vancomycin, intravenous, over 60 minutes, for MRSA infection, ordered by Dr. Lee.”
• Doctor: “Correct.”

That’s it. No extra steps. No fancy tools. Just speaking clearly and listening closely.

Why does this work? Because the brain catches mismatches when you hear your own words repeated back. A nurse once heard “Hydralazine” and thought “Hydroxyzine” - two completely different drugs. One treats high blood pressure. The other treats anxiety. The nurse read it back: “Hydroxyzine?” The doctor corrected her. A 10-fold overdose was avoided.

How to Say It Right: Phonetics, Numbers, and No Abbreviations

It’s not enough to say the drug name. You have to say it in a way that can’t be misunderstood.

Spell out drug names phonetically. Don’t say “Zyprexa.” Say “Z-Y-P-R-E-X-A.” Don’t say “Celebrex.” Say “C-E-L-E-B-R-E-X.” Sound-alike drugs are the #1 cause of verbal order errors. Celebrex and Celexa. Zyprexa and Zyrtec. Hydralazine and Hydroxyzine. These pairs have caused serious harm. Spelling them out removes the guesswork.

State numbers two ways. Say “15 milligrams” and then “one-five milligrams.” Say “500 micrograms” and then “five-zero-zero micrograms.” This prevents mishearing “10” as “100” or “5” as “50.”

Never use abbreviations. No “BID.” Say “twice daily.” No “QHS.” Say “at bedtime.” No “PO.” Say “by mouth.” No “IU.” Say “international units.” Abbreviations are a known trigger for errors. The Institute for Safe Medication Practices banned them in verbal orders back in 2020 - and hospitals that follow this rule see 40% fewer mistakes.

High-Alert Drugs: When Verbal Orders Are Forbidden

Some drugs are too dangerous to order verbally unless it’s a true emergency.

The Pennsylvania Patient Safety Authority and ISMP Canada list these as high-alert medications where verbal orders should be avoided if possible:

• Insulin
• Heparin
• Opioids like morphine or fentanyl
• Chemotherapy agents
• Concentrated electrolytes like potassium chloride

In most hospitals, you can’t order insulin or heparin verbally unless the patient is crashing. Even then, you need two nurses to confirm the dose. Some places, like Johns Hopkins, require all high-alert orders to be written - even if the doctor is in the room.

And yes, this frustrates some doctors. But it’s not about inconvenience. It’s about survival. In 2006, a premature baby in a NICU received the wrong antibiotic because two drugs were ordered at once: ampicillin and gentamicin. The nurse heard “200 mg and 5 mg” - but didn’t catch that the gentamicin dose was supposed to be 0.5 mg. The baby suffered kidney damage. That error happened because verbal orders were rushed, unclear, and unchecked.

Documentation: The Only Real Record

The only thing that matters after a verbal order is what’s written down.

The prescriber’s memory? Gone in 20 minutes. The nurse’s memory? Subject to fatigue, stress, and interruptions.

Immediate transcription is non-negotiable. As soon as the order is given, the nurse or assistant must enter it into the electronic health record - with all details:

• Full patient name and date of birth
• Medication name spelled out
• Dose with units (mg, mcg, mL, etc.)
• Route (IV, IM, PO, etc.)
• Frequency (twice daily, every 6 hours)
• Indication (why it’s being given)
• Name and title of prescriber
• Exact time and date the order was received
• Time and date the prescriber authenticated it

CMS requires authentication within 48 hours. But top hospitals like Mayo Clinic and Melbourne’s Royal Melbourne Hospital require it before the shift ends. Why? Because if the doctor leaves and forgets, the order stays unverified - and that’s a liability waiting to happen.

Who’s Responsible? Everyone.

This isn’t just the nurse’s job. Or the doctor’s job. It’s everyone’s job.

Nurses: You have the right - and the duty - to ask for clarification. If something sounds off, say so. “I’m not sure. Can you spell that again?”

Doctors: Don’t rush. Don’t talk over background noise. Don’t give orders while walking out the door. If you’re interrupted, pause. Say: “Let me finish this order first, then I’ll answer your question.”

Administrators: Train your staff. Make read-back part of orientation. Role-play bad scenarios. Reward people who speak up. Culture matters more than policy.

In a 2022 survey by the American Nurses Association, 87% of nurses said they support mandatory read-back. But only 58% said they see it done consistently. That gap? That’s where mistakes happen.

What’s Changing? And Where Are We Headed?

Computerized Physician Order Entry (CPOE) has cut verbal orders in hospitals from 22% of all orders in 2006 to about 10-15% today. In emergency departments, it’s still higher - 25-30% - because speed matters.

But even with better tech, verbal orders won’t disappear. Dr. Robert Wachter from NEJM Catalyst says it plainly: “Some clinical moments will always need spoken communication.”

The future isn’t eliminating verbal orders. It’s making them safer.

The FDA is working on a 2024 initiative to standardize how high-risk drug names are pronounced. Some hospitals are testing voice recognition systems that auto-transcribe orders - but only after the nurse confirms them with a read-back.

By 2025, KLAS Research predicts verbal orders will drop to 5-8% of all orders. But until then, every time you say “give this,” you’re holding a life in your hands. Don’t take it lightly.

Real Talk: What Nurses and Doctors Say

On Reddit’s r/medicine, an ER nurse wrote: “Verbal orders saved a trauma patient’s life. Written order would’ve taken 8 minutes. We lost 8 minutes, we lost the patient.”

Another nurse on AllNurses.com shared: “I once heard ‘hydralazine’ and almost gave it. But I asked, ‘Is that H-Y-D-R-A-L-A-Z-I-N-E?’ The doctor said yes. I almost gave a drug meant for high blood pressure to a patient with low heart rate. That’s why I spell everything now.”

A doctor in Sydney told me: “I used to think read-back was slow. Then I saw a patient get 10 times the right dose of morphine because I said ‘ten mg’ and they heard ‘one zero.’ Now I say ‘ten milligrams, one-zero milligrams.’ It takes 5 extra seconds. But I’d rather lose 5 seconds than lose a patient.”

Bottom Line: Clarity Is a Skill, Not a Suggestion

Verbal prescriptions aren’t evil. They’re necessary. But they’re dangerous if done carelessly.

The fix is simple: say it clearly, hear it back, write it down, and confirm it fast.

No shortcuts. No exceptions. No exceptions for busy days. No exceptions for trusted colleagues. No exceptions for “I know what they meant.”

Your words matter. The way you say them saves lives.