standing orders/JAHCO

[feebebe23]

I have heard that standing orders are now a no-no per JAHCO. However, I now work at a new facility and they have standing orders from all the docs. I work in L&D so having routine standing orders are very useful in most situations, i.e. routine admit, admit sch C/S, pitocin induction.....

Nine times out of ten we use the standing orders...

At the bottom of my order I write SOV(standing orders verified) Dr. Soandso/nurseRN

We recently had a JAHCO survey and they did not come to our unit, so this issue was not addressed.....so are standing orders really a violations of JHACO?

[Belinda-wales, RN]

You have to play the JAHCO game - its true thay no longer like standing orders thay are a big no so you change the name to order sets and JAHCO like it - you work it out because I can not - LOL

[feebebe23]

So "standing orders" are now called "order sets"?

[Daytonite, BSN, RN]

I'm looking at my copy of the CAMH (the JACHO Accreditation Manual for Hospitals) and here's what I'm finding directly from the standards:

Medication Managment Element of Performance #6

-

The hospital specifies the required elements of any of the following types of orders that it deems acceptable for use: standing orders.

Medication Management Element of Performance #8

- Reviews and updates pre-printed order sheets as needed.

It is quite possible that a facility can establish a performance indicator to not use pre-printed standing orders if they so see fit. In doing so, however, they are obligated to follow that decision. Unless you have heard that from your manager and those standing order sheets continue to be present on your unit then it is OK for them to be used. A patient's physician should always be notified and any standing orders reviewed and verified ASAP to CYA. That should be clearly stated in your hospital policy manual on the RNs responsibility regarding following physician orders. Although JCAHO, or The Joint Commission as they now want to be known, looms as an intimidating presence, your hospital policies and procedures ALWAYS take front seat to what you need to be doing. It is the responsibility of hospital management to write policies and procedures that are in compliance with JCAHO elements of performance, not the nursing staff to worry about. I know, when I was a manager, I was on our facility JCAHO committee and this is part of the work that our committee did. If you are even in doubt about a policy, take your questions up the chain of command starting with your manager. Your allegiance is to your facility, not JCAHO. Let the administrators deal with JCAHO. Let me put this another way...you're more likely to get in trouble for not following your hospital policy than by doing what you think JCAHO wants done.

[MemphisOBRNC, BSN, RN]

Several years ago, we, too, got away from using routine or standing orders per J.C. recommendation. Now they want Read Back on all orders not written by the MD. My question: do you now have a protocol for what to do with all those L&D patients that appear at your door? In other words, we always document: admit for observation, fetal monitor, vag. exam as indicated, urinalysis etc. We put phone order per Dr. X / our name and stamp it with the Read Back stamp. The problem I have is that it may be 1 or more hours before the Dr. is actually notified that the pt. is there. Isn't that false documentation? Our registration dept. will not put the pt. in the computer if we don't send down orders. Based on EMTALA, it's the law that we have to see these pts. and do a Medical Screening Exam so why not have a protocal. Makes too much sense, I guess. Any thoughts?

This year, one of the biggest J.C. focuses was overriding medications. If the order sheet has not been sent down to the pharmacy and the meds. were not 'put into the OmniCell', we had to document on paper that the med. was urgently needed and the order had been reviewed by 2 nurses, both having to sign the form. It was then faxed to pharmacy. Since our babies are not born when our Vitamin K, Erythromycin ointment and Hep. B vaccine is pulled for delivery, the override is done on every baby. Since the order sheet had no name and MR # on it (the baby isn't born yet) pharmacy can not enter the meds.

At what point do you pull your baby meds?

[RNLaborNurse4U]

All of these rules and standards are ridiculous, especially when it comes to L&D. We have patients that come in the door 24/7 for things that need evaluated immediately, and without a doctor in house 24/7 and readily available to give orders immediately, we NEED to have standing basic orders to triage a laboring patient.

Something needs to be done to change the way JHACO and the Dept of Health regulate the L&D industry.

I can see an end in sight to us being able to override in our Pyxis machines for meds that patients need imminently. It's coming - count on it!!