Telephone calls from patients seeking a nurse's advice have increased. Accordingly, nursing informatics must include and address the issue of providing telephone consultations to patients, whether one is a nurse on-call or a triage nurse. Nurses must also be certain that any person they are responsible for supervising understands how to address telephone consultations as well (Buppert, C., 2008). Telephone consultations can be beneficial in that minor illnesses can be addressed without an office visit, recurring problems can be addressed without an office visit and the cost of an office visit is reduced (Medical Insurance Exchange of California (MIEC), 2008). Despite the benefits, telephone consultations can also create liability risks. In many ways they pose a higher level of risk than in-person consultations because there are certain observations that cannot be made over the telephone and a first-hand examination is not being completed (Sosin, 2006). The nurse must use their best judgment in evaluating the patients statements. Depending on the position of the nurse, there are several ways that a patient telephone call can be handled. The nurse can refer the patient to their treating health care provider, refer the patient to the facility call center or “try to gather enough information to give the patient sound professional advice”(Austin, 2008, p. 6). If the nurse decides to address the patient's issue themselves, they should make sure that they are not “exceeding the scope of nursing practice or providing advice that's not up to the standards of care” (Austin, 2008, p. 6). Providing advice over the telephone establishes a duty on the part of the nurse to provide advice that is in keeping with accepted standards in the nursing profession. If this duty is breached and results in harm to the patient, the nurse is open to legal liability for negligence, as well as, professional licensing issues (Austin, 2008). The nurse should also make sure that they know their facility's policy concerning telephone communication with patients and make sure their malpractice policy covers telephone advice. Following established facility guidelines reduces the chances that the nurse will provide unclear advice or advice that exceeds the scope of nursing (Sosin, 2006). Issues that can create complications in giving telephone advice include patients inaccurately describing their problem, having others call on their behalf and asking unclear questions. The general increase in telephone call volume and language barriers can pose problems as well. To combat these issues, nurses must be certain to listen very carefully, try to speak using everyday terms, be careful of any advice given without the patient's medical records on hand and do their best to ensure that the patient is accurately describing their issue by asking specific follow-up questions. Before completing the handling of the telephone call, the nurse should ensure that the call is appropriately documented. Documentation is probably the most important follow-up action that should be taken. “Documenting is essential, not only for the patient's safety but also to protect [the nurse] from legal problems if someone disputes [the nurse's] version of events” (Sosin, 2006, p. 7). Nurses should be sure to document important telephone calls from patients, all calls received when on-call and calls in which medical decisions are made. “Failure to memorialize this type of communication creates significant gaps in the documentation of patients' care and treatment” ((Medical Insurance Exchange of California (MIEC), 2007, p. 4). When possible, the patient's own words should be used in the documentation of a telephone call. Overall methods that may assist with improving telephone consultations include ongoing training, quality assurance monitoring of telephone calls, and maintaining adequate professional liability coverage (Sosin, 2006). Providing telephone consultation has become a normal part of a nurse's function. Although it has become commonplace and can be very helpful, great care should always be taken to ensure that the safety of the patient is protected, as well as, the nurse's profession when giving advice. Applying the suggested methods before, during and after the telephone call, greatly increases the effectiveness of the advice given, while protecting the nursing professionally.

Buppert, C. (2008). Understanding medical assistant practice liability issues. Dermatology Nursing. Retrieved from http://findarticles.com/p/articles/mi_hb6366/is_4_20/ai_n29459112/

Sosin, J. (2006). Judgment Calls. Nurses.com. Retrieved from http://news.nurse.com/apps/pbcs.dll/article?AID=2006602270363

Austin, S. (2008). Are you liable for telephone advice?. Med/Surg Insider, 38, 6-7. doi: 10.1097/01.NURSE.0000334058.98940.62

Medical Insurance Exchange of California (MIEC). (2007, February). Telephone Communication: Did you hear what I heard? Write On!, MIEC's Documentation Newsletter. 1-6. Retrieved from http://www.miec.com/Portals/0/WriteOn/Writeon1_online_02.07.pdf

Medical Insurance Exchange of California (MIEC). (2008, February). Telephone Advice Programs-the Benefits and Risks. Managing Your Practice. 1-6. Retrieved from http://www.miec.com/Portals/0/ManagingYourPractice/MYP7.pdf