Extremely confused about protocols and orders sets!

[Axmann, RN, BSN, NREMT-B]

I just started as an RN on a med-surg floor at a major metropolitan Level I trauma center.

I am so extremely confused about protocols and order sets. What can be implemented without a doctor signature and what cannot?

A good example is a heparin flush policy for PICCs. I've asked multiple people and hear multiple answers on how a heparin flush order should be entered by an RN at my facility.

My facility does have an "IV Access Device Management" PROTOCOL ORDER SET, but for some reason, I can't find a standalone PROTOCOL document for it. Most of the nursing protocols at my facility (Narcan, flumazenil, hypoglycemia) have standalone "Protocol" documents on the facility's intranet page that talk about the protocol, as well as "Protocol ORDER SET" pages. For some reason, the IV Access Device Management protocol only has the order set document, but no description of the protocol.

I'm extremely confused about the policy. My preceptors can't give me a straight answer, nor is the EDUCATOR able to clarify it either!

I'm at my wit's end and I don't want to mistakenly implement heparin flushes by protocol if we're supposed to wait for an MD signature first.

[blondy2061h, MSN, RN]

We have multiple protocols, for insulin, heparin, electrolyte replacement, and pain management. However, the provider needs to order that the patient be placed on that protocol, then the relevant orders show on their MAR. Few protocols are universally implemented, though some are (i.e. MRSA screening on admission). Universally implanted protocols should also be implemented into order sets somehow.

[roser13, ASN, RN]

It's no wonder you're confused, if your Educator can't even give you a straight answer. That's too bad, because I think that only someone from your facility can give you a straight answer. These issues are totally facility-specific.

[klone, MSN, RN]

That's pretty ridiculous that your educator cannot even answer that question. I would look at your facility policies and procedures and see if anything is addressed regarding "orders per protocol".

Typically a protocol is a series of actions or tasks that can be done without a formal written provider order. An order set is a group of additional orders that occur when a particular order is chosen (e.g. "admit to inpatient" would then open the order set that would require the provider to choose vital signs frequency, diet, activity, etc). Typically the order set will have various options that the provider will have to choose when putting in the order. An order set is still something that needs to be initiated/ordered by the provider; whereas a protocol typically does not.