Med/Surg Standing Orders

[military girl]

Hello to all,

It's been a year since I logged on. Missed the site.

Just a question, in your facility, what types of medications are used for standing orders(ortho, med/surg, peds). Also, are your physicians okay when you give a med that should be covered with a standing order?

I'm new to Med/Surg and want to develop a list of medications that our doctors will approve for standing order meds(so we're not bothering them at 2am for someone who has a fever).

If there is a post already about this, please disregard.

Thanks,

Military Girl (playing in the big sandbox)

[meownsmile, BSN, RN]

Due to joint commission we have very few to no medications that are standing order. I wish we could use suppositories such as dulcolax as a standing order but not anymore. We have a list posted but we actually use so few of them that i dont even remember what is on it at this point.

I guess standing orders arent really a good thing anyway because there is always going to be that one patient that reacts badly to something given that the doctor wasnt aware of prior to giving (allergy, other medical issue etc.). So for safety dont worry about standing orders on a med/surg/ortho floor. Call the doctor, thats what they get paid for.

[RNinSoCal]

At my hospital we use a form called "General Admission Orders". All the MD has to do is check the little boxes next to routine meds and sign the bottom. Our pharmacology system flags any allergies before dispensing (computerized system). The form contains things like MOM, DSS, Tylenol, Zofran, etc and blank spots for diet, code status, activity, therapies, etc. Any unwanted items can be crossed out. All medications have the reason after them (ie Tylenol ...for fever > 38.0, Zofran...for nausea/vomiting just for JCAHO. There are other forms like this for post op hip, knee, and abdominal surgery. It really has helped prevent those late night phone calls to a certain extent. The hospitalists and surgeons use them more than other MDs. I never have to question whether a surgeon wants a dressing reinforced or changed if the form is filled out!

[PamRNC]

Our computer physician order entry system (Eclipsys) has something similar... Order sets that pull up all the general standing and prn meds for a given diagnosis/procedure. All the docs have to do is click on/activate the orders they want (Tylenol, Percocet vs Vicodin, labs, diet, allergies, etc...) and voila! If the docs use it right it will cover everything, A to Z, parameters for prn meds, notifying the docs about abnl VS, etc and so forth.

[meownsmile, BSN, RN]

We too have preprinted admit orders with meds etc. However, we find the docs dont use those correctly either. They either wont mark the meds and add the patients home medications(expecting us to do it for them) or they wont use them at all and write their own orders in which of course they never write for those meds and things that would be considered a standing order. We end up calling them anyway.