standing orders

altomga, ADN, BSN, MSN, DNP, RN, APRN · Jan 27, 2003

My hospital does have standing orders (or shall I specify) certain doctors do. We have a group of nephrologists that have them, I know on the cardiology floor they have some. The hospital itself does have a insulin gtt and heparin gtt protocol that all you do is plug in the numbers on one and follow the other. I personally love the standing orders (PRN) b/c it makes it easier. And like you said, nothing worse than having to call a doc in the middle of the night and getting yelled at for Tylenol; but then again; they should have thought ahead and ordered it. (That is what I usually tell them;) ) It simply takes common nursing judgement to know whether or not you should use some of the PRN's on the sheet. Don't use it simply b/c you have it!

renerian, BSN, RN · Jan 27, 2003

We had direct admit/standing orders for sickle cell crisis clients and for inital admission leukemia patients. Made things alot smoother.

renerian

NS_RN · Jan 27, 2003

Well, we do have protocols/routine orders for COPD,heparin gtt and DKA. But not standing orders per say for prn's like laxitives and tylenol. I work on a 34 bed medicine unit...and standing orders for those things would save alot of time and phone calls.

Jay Levan · Jan 27, 2003

Hey Angiebruno, Most hospitals have "Standing Orders" however I find that all to often, preceptors either Assume or conveniently brush over this information, with little or no time spent detailing this most interesting information. :eek:

Usually each facility will have a committee, comprised of several Physicians working on a specific unit. Also the DON, or Education Nurse, or both will usually sit on this committee. I believe the "Ball" gets dropped by anyone of these persons or the preceptor. Add to this possibility, that no two facilities handle this subject the same, some store these orders in a file cabinet, some store them in a closet, etc. etc. Another confusing aspect is that all Doc's have their Ego's in play so that no standard form is good for each individual Physician. Are you getting the picture I'm sending you. Oh, almost forgot to mention that a particular Physician may approve of let's say Tylenol when he signs off on a stadardized form, but then for reasons only known by that Physician, at some point will decide that Tylenol is dangerous because of the effects it may have on someone's liver :eek:

Please forgive me for not adding more finite detail, I think I have summed up how I feel about "Standing Orders" but I have only scratched the surface of the possible problems I have encountered with this subject. Bottom line is you must get to know the Doc's you will be dealing with and make your own informed decision as to whether or not to use this most perplexing tool, to avoid having to call when you are not sure. :cool:

May "The Force" be with you.

Sleepyeyes · Jan 27, 2003

Our unit has standing orders for Tele, MI, and CVA.

I love it because the prn orders include tylenol and whatever laxative the pt's constipated lil heart desires....

purplemania, BSN, RN · Jan 27, 2003

why can't you call the admitting MD or ER doc?

fab4fan · Jan 27, 2003

The ED doc is not the house doc; he is the doctor for the Emergency Dept. He may respond in code situations, but that's about it...most ED docs are not covered by insurance for anything more.

Can you imagine the turf wars that would happen if the ED docs started OKing things on pts. of other docs? It could get ugly. And the ED doc doesn't know the pt., so I can't imagine any ED doc feeling comfortable ordering things in this situation.

It's the attending's responsibility to see that these things are taken care of; if he has to be called, then it's his responsiblity.

P_RN, ADN, RN · Jan 27, 2003

re tylenol....only once in all my working i did see an allergic reaction to tylenol. it was in parafon-forte . the med was ordered by the doctor, but the nurses "should have known" that it might make the patient have a reaction......you know kick the dog (nurse).

nowhere at all was an allergy listed .....not on the admission form, doctors records nowhere!

it was a really bad experience! i'd hate to see what would have happened if the nurses had just "given" tylenol on their own

Sally_ICURN · Jan 27, 2003

We have 4 pages of pre-printed orders for our cardiac surgery patients and 6 pages for our transplant patients. The docs simply put a check mark next to what they want and for meds, they write in a dose. They leave us with orders for a variety of IV drip meds, fluids, a wean to extubate order, and post extubation orders. When the patient comes to us straight from the OR, we get them settled, get report from the anesthesiologist and then they all split leaving the nurses to recover the patient from anesthesia and automously handle the post-op care. Of course when there are complications, we call them without hesitation, but on nights most often the docs don't see the patients again until morning rounds. Our orders include everything from under what circumstances to give blood to an order for MOM and tylenol to restraint orders. It's really great being able to use your own nursing judgement when it comes to patient care and I love my job!

~Sally :cool:

niteshiftnurse · Jan 27, 2003

all I can say is "God Bless" the docs who have standing orders. It sure would save alot of undo phone calls

deespoohbear · Jan 28, 2003

I figure if the doc isn't smart enough or with it enough to have standing orders or order them when a patient is admitted, than they deserve to be called at 2 am for something like Tylenol.... I admitted a pt with pneumonia today. Nagging, relentless cough. The patient is probably going need something for her cough during the night. I called the doctor's office at 2pm with my request. Got a call back at 3:30 from the nurse saying that the doctor was thinking about what cough syrup to order. HELLO? I didn't think ordering cough syrup was that huge of a deal...never did get an order. So when I gave report to the night shift tonight I told them I tried to get an order but the doc never called back....Oh well. The night nurse said well, when she has to call him at 2am she better not here any static..... :rolleyes: