standing orders in your hospital

  1. I work in a small community hospital. Currently we have no standing orders, so if a patient developes a fever and has no order for Tylenol (and it does happen), we have to call physician at 2am for an order. I am trying to come up with a list of standing orders to present to the medical committee to have approved for standing orders (for adults). If anyone has any suggestions, it would be appreciated.

    Thanks,

    Kristy
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  2. 25 Comments

  3. by   ZootRN
    ABG for patient with Sat <80
    Occult blood sample if rectal bleeding is suspected
    C-diff testing for pts having diarrhea

    We have bunch of ICU protocols, but I know floors have to call doctors for everything, Tylenol for headache included. Seems like waste of time, and can be easily ordered and implemented by nurses.
  4. by   purple_rose_3
    Our standing orders have tylenol, colace, maalox, mom, ambien uh... if i think of some of the others I will let you know.
  5. by   santhony44
    Quote from purple_rose_3
    Our standing orders have tylenol, colace, maalox, mom, ambien uh... if i think of some of the others I will let you know.
    It's also useful to have parameters for when the docs want to be called- as long as they don't yell when you do so.

    Sleeping, headache, constipation, indigestion...

    Maybe add something like robitussin prn cough?

    I think standing orders and parameters can be really useful; I'm surprised your docs haven't thought of it before.
  6. by   horrorxgirl
    The most common standing orders I've come across were Tylenol, and some sort of constipation protocol that includes MOM or colace, and then followed by a fleets if ineffective. I've yet to see Maalox as a standing order, but I think it should be. Nothing is more annoying than calling a doc in the middle of the night because your patient is complaining of bad indigestion.
  7. by   TrudyRN
    If the docs don't order things like Tylenol, they deserve to be called at 2 a.m. You'd think they'd remember after one middle of the night call for such a small yet important matter.
  8. by   purple_rose_3
    Trudy, I think that is a really harsh statement.
  9. by   Alibaba
    We have
    Tylenol gr10 (pain, fever>100)
    MoM 30cc (constipation, check for impaction) call MD if not resolved
    Robitussin 10cc Q6 *3days call Md if not resolved
    O2 to keep Sat level >90%
    TAO for skin tears.
    Acidophollus for all ABT
    Immodium for diarrhea

    We do not have any sleep meds on standing orders and have to call MD for those. Can not think of others, but we have two pages of standing orders. Our MDs definately don't want to be woken up NOC unless it is an emergency.
  10. by   P_RN
    JMHO but I think the standing orders should originate between the pharmacy and the specific doctor. Tylenol for a fever.....what if the fever is an early sign of something worse? Perhaps pulmonary toilet instead of tylenol.
    Cough? maybe something beside Robitussin?
  11. by   jodi_cmsrn
    We have cepacol lozenges and/or chloraseptic spray prn for all patients with NG tubes.
  12. by   NurseCherlove
    gonna have to agree with Trudy on that one, harsh or not.
  13. by   crissrn27
    Quote from NurseCherlove
    gonna have to agree with Trudy on that one, harsh or not.
    :yeahthat:
  14. by   crissrn27
    Not adult care here, but a good idea, we have CBC-D and blood cultures ordered under certain circumstances.

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