Orders, handoffs and other people

Entering a protocol order under a provider's name without making it look like theirs

The EHR puts a doctor's name on your protocol orders. Your note is the only thing saying the doctor never decided it.

7 min read built on 4 full opinions updated 2026-10-21

Written by a med-surg RN, ten years, day shift. Why there is no name on it · How this guide is made

Denise reacting to this topic
All sections

The EHR wants an ordering provider on almost every lab, test and med. That includes the ones you start yourself under a standing protocol. So a doctor's name lands on an order the doctor may never have seen. Your note is the only thing that tells the next reader what actually happened.

Key points

  • Name the protocol in the order itself: protocol or order-set name and number. If your EHR has a protocol order mode, use it. Don't pick verbal or telephone.
  • Chart the trigger, meaning the actual value or finding and the time. K 3.2 at 0540 works. Low K doesn't.
  • Chart who you told, when, and how. If policy requires a cosign, say who it's routed to.
  • Verbal order means a provider actually spoke to you. If nobody did, it isn't a verbal order, even if you plan to get it signed later.
  • Before you act on a standing order, check the chart for anything that conflicts with it: refusals, allergies, a newer order.

What to write

How it often gets charted What it should say
BMP ordered.BMP ordered per ICU Electrolyte Replacement Protocol #EL-04. Trigger: K 3.2 at 0540 on AM labs. Dr. Patel paged 0550 per protocol notification step; cosign routed.
KCl 20 mEq PO given per Dr. Patel.KCl 20 mEq PO given 0610 per Protocol #EL-04 (K 3.0 to 3.4 range). Ordering provider field shows Dr. Patel per EHR default; Dr. Patel not contacted before administration, notified 0615 by secure chat.
VO Dr. Lee: 12-lead ECG. (no call happened)12-lead ECG obtained 0215 per Chest Pain Standing Order Set CP-1. Trigger: pt reports new substernal pressure 6/10, HR 112. Dr. Lee called 0220, read ECG at bedside 0225, no new orders.
Blood cultures x2 drawn. MD aware.Blood cultures x2 drawn 2240 per Sepsis Screen Protocol SS-2. Trigger: T 38.9, HR 118, RR 24 at 2230. Dr. Okafor notified 2235 by phone, read back, plans to see pt.
Sedation vacation held.0400 sedation interruption per Protocol SAT-1 not started. Reason: Dr. Jaggers order at 2100 to taper propofol supersedes SAT-1. Night charge RN informed.
Insulin per sliding scale.Insulin lispro 4 units SQ 1130 per Correctional Insulin Protocol CI-2, POC glucose 248 at 1125. No provider call required at this range per protocol.

Template

Note when you start a protocol order

[DATE] [TIME]
Order initiated per [PROTOCOL / ORDER SET NAME], [PROTOCOL NUMBER].
Trigger: [FINDING WITH VALUE], obtained [TIME OF FINDING].
Protocol criteria met: [WHICH CRITERION, E.G. K 3.0 TO 3.4].
Order entered: [DRUG, DOSE, ROUTE, FREQUENCY] / [TEST NAME].
Order mode in EHR: protocol. Ordering provider field populated as [PROVIDER NAME] per EHR default.
Chart checked before entry for allergies, refusals and newer orders: [NONE FOUND / WHAT WAS FOUND].
Provider notified: Dr. [NAME], [TIME], by [PHONE / PAGE / SECURE CHAT].
Provider response: [NO NEW ORDERS / NEW ORDERS AS ENTERED / WILL SEE PATIENT].
Cosign routed to Dr. [NAME] per [POLICY NUMBER], due [TIMEFRAME PER POLICY].
Patient response: [ASSESSMENT AFTER INTERVENTION, TIME].
[YOUR NAME], [CREDENTIALS]

Note when a provider really gave you a verbal or telephone order

[DATE] [TIME]
[Verbal / Telephone] order received from Dr. [NAME] at [TIME].
Order: [DRUG, DOSE, ROUTE, FREQUENCY] / [TEST NAME].
Reason given by provider: [FINDING OR INDICATION].
Order read back to Dr. [NAME] and confirmed at [TIME].
Entered in EHR as [verbal / telephone] order. Cosign routed to Dr. [NAME].
[YOUR NAME], [CREDENTIALS]

Note when a protocol step is held or overridden

[DATE] [TIME]
[PROTOCOL NAME], [PROTOCOL NUMBER] step [STEP] not carried out at [SCHEDULED TIME].
Reason: [SUPERSEDING ORDER BY DR. NAME AT TIME] / [EXCLUSION CRITERION MET: FINDING WITH VALUE].
Dr. [NAME] notified [TIME] by [METHOD]. Response: [RESPONSE].
Charge RN [NAME] informed [TIME].
[YOUR NAME], [CREDENTIALS]

Message to the provider

Dr. [NAME], this is [YOUR NAME], RN, [UNIT], about [PATIENT NAME], room [ROOM], MRN [MRN].
At [TIME] I entered [ORDER] per [PROTOCOL NAME], [PROTOCOL NUMBER].
Trigger: [FINDING WITH VALUE] at [TIME].
The order shows under your name per EHR default and is routed for your cosign.
Please let me know if you want any change. Current status: [BRIEF ASSESSMENT].

Words to avoid

Word or phrase Why it hurts Use instead
per Dr. XReads like the doctor's personal callper [protocol name and number]
VO or TO when no one spoke to youClaims a conversation that never happenedProtocol order mode, plus a notification line
MD awareWhich MD? When, how, and what did they say?Dr. [name] notified [time] by [phone/page/chat]; response: [...]
per orders or per protocol aloneDoesn't say which protocol or what met its criteriaProtocol name, number, and the trigger value
will get cosignedAdmits the order isn't authorized yetcosign routed to Dr. [name] per policy [number]
held with no reasonThe next reader has to guess who decidednot given: [reason]; superseding order [time] by [name]

A protocol order with nothing around it

The usual mistake is a protocol order with nothing around it. You enter the order, the ordering provider field fills in with the attending's name, and you don't write a note. Six months later that order reads exactly like the attending's own decision. Nothing shows a protocol was involved. Nothing shows what finding met its criteria, or that anyone told the provider.

The opposite mistake is worse. Some nurses pick verbal order as the mode because it's the fastest way through the screen, or because they mean to call the doctor later. Now the record says a specific person gave you a specific instruction at a specific time. If that never happened, the entry is false the moment you sign it. A cosign afterward doesn't change what the entry said when you made it.

There's a quieter failure too. A standing order runs on its own criteria and doesn't read the rest of the chart. Say a refusal form, a newer order, or a reason to hold is sitting somewhere else in the record. The protocol won't catch it. You have to.

Bottom line

If a provider didn't tell you to do it, don't chart that they did. Name the protocol. Name the finding that triggered it. Say who you told.

Official guidance

  • A standing order or protocol only counts if an authorized provider approved it in writing ahead of time. A unit can't make one up out of habit. (Washington State Board of Nursing, NYSED Office of the Professions)
  • The protocol should spell out the specific task: drug, dose and route, or the named test. That's what lets a nurse act on it without a separate order every time. (NYSED Office of the Professions, Holt Law)
  • Tag protocol orders as protocol in the EHR. Then they don't read as the provider's own choice, even with the provider's name on them. (URMC policy, r/emergencymedicine)
  • The record has to show why the test or treatment was ordered, including the assessment findings behind it. A name in the ordering field doesn't do that. (CMS, LegalClarity)

In court, 2000–2014

What happened in 4 court cases

Wallace v. Methodist Hospital System: District Court, S.D. Texas, 2000. This was a pregnancy discrimination suit, and the chart facts come from the nurse's own testimony. The written order said to begin tube feeding. She swapped the Salem sump for a small bore feeding tube and charted a verbal order in a medical fellow's name to place the tube and follow up with an X-ray. The fellow never gave that order. She testified she planned to get the fellow's cosign before her shift ended. The attending read the chart first. At trial she agreed the counseling record was factually correct when it said she performed the procedure without an order, "then wrote as a verbal order. No verbal order had been given." She was fired. The jury found for her, and then the court granted the hospital judgment as a matter of law. What it means for your charting: a cosign you plan to get later doesn't make a false verbal order line true now.

Salandy v. Bryk: Appellate Division of the Supreme Court of the State of New York, 2008. The surgeon's standing orders called for a postoperative autotransfusion. A resident wrote the order under them, and staff carried it out. The patient's signed refusal of blood products was in the same preoperative packet. Nobody had flagged the conflict between that refusal and the consent form. The appellate court reversed summary judgment against the hospital and sent the question of the hospital's knowledge to a fact finder. So the standing order ran exactly as written. The paper that contradicted it sat right there in the chart.

Bennie Joe Poteet, II, Individually and by and Through Evelyn Poteet, as Conservator of Bennie Joe Poteet, II v. National Healthcare of Cleveland, Inc.: Court of Appeals of Tennessee, 2011. The hospitalist signed a protocol form order for daily sedation interruption. At 4:00 a.m. it wasn't carried out. The physician who wrote the ICU protocol testified that "the ICU nurses had discretion whether or not to follow the order under certain circumstances." He also testified that his later order to taper the sedation superseded the protocol order. The jury found for the nurses and the physician. Look at the questions that came up afterward: which order governed, who decided, and why. A note written at the time answers all three. Nobody has to testify from memory.

Fromer v. Corizon, Inc.: District Court, S.D. Indiana, 2014. The court didn't evaluate the charting here. The case is on this list only because the record has a real protocol entry in it. A triage nurse described the infected toes and wrote "Keflex given per protocol" along with the patient teaching. A separate entry notes that the physician approved a nurse's instructions. You can read it and tell what the nurse did under protocol and what the doctor signed off on. That's the separation you want in your own notes.

Court decisions

Published decisions, linked to CourtListener.

All decisions behind this guide

From nurses online

Quoted as written. Opinion, not a source.

  • I frequently document orders in ... Or provider gave verbal order for IV instead of IM for let’s say toradol or phenergan. Orders actually entered are cosigned electronically....

    r/nursing on Reddit: Verbal Orders reddit

  • Often times icu docs leave standing orders and or protocols set in place for certain scenarios and or admitting diagnosis . For example if we get a dka we have an entire protocol to run off in terms of order sets . ... This was outside of an established protocol. It varies by physician preference an

    r/nursing on Reddit: RN entering MD orders without MD knowing reddit

  • I don't understand, units in my hospital including the ICU have standing order sets. So the orders to replace electrolytes, order ECG's, x-rays etc. are all pre-signed by the admitting physician.

    r/nursing on Reddit: I'm not a doctor, I just played one on my unit reddit

  • Depends on the facility you’re working for. My current facility doesn’t have strict rules against it, as long as you’re clarifying what the orders are and clarifying that the physician wants You to enter that order, and it’s for something you can order.

    r/nursing on Reddit: Entering verbal orders for providers - is it really bad? reddit

Other guides

Advice, not law.