[defeatedcreek]

Military medicine is inexorably "military." It is subject to the same barriers and bureaucracy of the rest of the military.

In my Mom's ward at our community hospital back home nurses had "standing orders." These orders involved small doses of nursing intervention medications for patients without requiring a doctor's order. This saved time when you had a doctor who did not adequately predict his patients and order proper PRN meds. Standing orders usually involved OTC meds in small doses.

We have had problems lately with patients who had intense nausea, constipation, and even mild anaphylaxis. We had to page a doctor at 0200 or any other time to ask orders for the simplest medications.

With standing orders the doctors reviewed the standing orders and when a patient was admitted the doctor could say on his orders to adhere to the standing orders or not depending on the patient's allergies, condition, etc.

I would like to see this implemented in our hospital because frequently we deal with military retirees in precarious states. We have protocols for MI, DKA, and cardiac arrest yet we cannot do something as simple as give someone mylanta or tylenol.

Any advice on how we can get a program like this going?