Communication Orders

Communication orders allow prescribers to record precise instructions for healthcare interventions performed by other members of the healthcare team. Communication orders can round out a multidisciplinary care plan when conditional actions by other healthcare professionals need to be supported as actionable and trackable requests directly attached to a specific patient encounter.

Purpose

Communication orders are not a substitute for clinical communication (sticky notes, secure messaging, In Basket, paging, etc.) or clinical documentation activities (progress notes, discharge planning, etc.). Rather, they are used to set limits on the application of other orders (e.g., parameters to be followed when deciding when to alert a responsible prescriber to concerning clinical observations), guide application of another's professional skills (e.g., instructions about bedside care, dressings or other in-person interventions) or over-ride default protocols (e.g., instruct to discontinue vital sign measurements as part of a compassionate care plan).

Communication orders are not a substitute for available patient care orders. Most interventions performed by nursing and allied health (e.g., dressing instructions, wound management, Glasgow Coma Scale) should be ordered through individual orders or with purpose-built order sets and panels (e.g., "Burn/Wound Management" order set). Patient care orders have features that integrate with the nursing and allied health task management tools.

Communication orders can share some characteristics with procedure orders, having frequency, applicable time interval(s) and process details. However, they will not generate a task for nursing or allied health and currently do not appear on reports.

Placing Orders

While most communication orders bear a "Nursing Communication" label, there are some that relate to dietician or other allied health actions. A Order Search for "communication" will find all.

The "comments" field should be used to provide instructions; a "hard stop" because there is no point to a communication order without provision of instructions.

Communication orders generate tasks and reminders in team work-lists. Actions taken are logged.

Protocolized Orders

In some situations, a Nursing Communication order can be used to endorse initiating a course of action that may include protocol-based action that the healthcare team may initiate, with provision for later co-sign by the most responsible prescriber. A prescriber could, for example, place a nursing communication order to initiate a rapid response protocol for a patient with signs of deterioration. The team can then follow established processes to gather additional information that will be ready for further review, actions and more definitive orders.

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