Any other facilities with two sets of standing orders?

[unsaint77]

Again, it's me a new grad nurse at a LTC facilility's TCU. (We have pts with iv, picc, ng, nj, o2, cpm, but we have no tracheostomy or EKG capacity)

We have two different sets of standing orders due to different admitting doctor groups. They are pretty basic but different. For example, one set has s/s order for hyperglycemia but the other doesn't. One set requires foley cath changed before UA/UC specimen collection, and the other set doesn't specify that (I will post this question separately).

Anyone else in a facility with two or more sets of standing orders? I don't think it's a safety issue since there is no contradicting orders on urgent matters such as respiratory distress or chest pain. But it's such a hassle for nurses to handle two sets of standing orders.

Thanks.

[tyvin, BSN, RN]

The last LTC place I worked had 3 sets of standing orders; one for each doc (I thought that's how it was everywhere). All docs are different and some are more comfortable letting the RN decide and some wouldn't trust an RN with a bandaid. The more standing orders I have the better... lets me go ahead and treat the person instead of tracking down the doc at 02:00.

[classicdame, MSN, EdD]

typical in a hospital. Just like Dr. A cannot write orders for Dr. B, or give them over the phone, the "standing orders" do not transfer either.

Why don't you recommend to your DON that you have one set, based on evidence, that the Board of Directors, or the Medical Staff agree upon? We found this to be much easier. The ordering MD still has the privilege of making adjustments, but they MUST be in writing or electronic.

And before you get to talking about nursing protocols, please note that some states prohibit this unless the nurse is an advanced practice nurse. Protocols have a specific legal definition, at least in Texas