Help. Physician orders with parameters

Nurses General Nursing



Im seeking information on nurse practice acts and what to do with physician orders that involve parameters. I hoping to get factual information rather then opinions just because opinions sometimes are not necessarily correct per State board of nursing and Nurse practice acts.

This involves orders in Texas, but if you have experience in your state please share.

My question is whether or not nurses are correct in following orders with parameters.


May increase or decrease patients most current dose by up to 10% per patient request. May increase 1 time per week. No more then 4 changes in 6 months.

Based on my understanding of the rule this is a proper order. There is a limit to how much the patients dose can be changed, there is a time limit on the change. I know that patients are considered part of their treatment and are allowed to be active and request changes so I feel given a parameter that the patient is requesting we as nurses are allowed to follow this order.

This comes from patients with implanted pumps that deliver medications into the intrathecal space in the spine. Pumps are continuously running and as the nurse we manage filling pumps and increasing or decreasing dosages. However some nurses feel that we have to have a set dose while others have said that we are allowed to follow certain parameters as long as its the physician writing the standing order even if it has patient being active in that decision.

I have been looking up Nurse practice acts, Texas board of nursing rules, and guidelines but am having a hard time finding actual information that backs either for or against following these orders. Any help or insight would be appreciated.

Specializes in OR, Nursing Professional Development.

Have you tried reaching out directly to the TX BON? They may be able to provide guidance specific to your NPA.

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