Nurse initiated orders

[Spannjt]

Hello,

I am in the beginning phase of trying to start NIO at our outpatient clinics and UCC. The goal is to have our RN's work to the top of their licensure, empower them, improve access, and delivery safe, effective care. We have created algorithms for the below 5 minor conditions. My question is I have been able to find little EBP in regard to this. There is a lot of information on Nurse-Led clinics, however very little on NIO. Any input links suggestions would be helpful, thank you for your time.

Yours in Nursing,

John

-Acute Uncomplicated Female Cystitis

-Adult Cold Symptom

-Adult Strep Throat

-Nausea, Vomiting, Diarrhea

-Pediatric Cold Symptom

-Pediatric Strep Throat

1. Purpose: To provide guidance for utilizing evidence-based Nurse Initiated Orders (NIOs) on applicable patients who present to primary care and Urgent Care seeking treatment for low acuity symptoms.

2. Scope: Applies to all XXX Hospital and Branch Health Clinics, our target populations are patients 6-65 years of age who meet the criteria in Enclosures 1-6.

3. Background: Caring for minor illnesses throughout primary and urgent care clinics creates a barrier to same-day/acute access. Nurse initiated orders (NIO) have proven to improve access, reduce cost, improve patient satisfaction, and increase work fulfilment. They are developed through an interdisciplinary process involving physicians, clinicians and ancillary personnel with a vested interest in the process and delivery of patient care for which they are intended. Approval by Executive Committee of Nursing Staff, Medical Executive Committee, Pharmacy and Therapeutics Committee, and Standards and Practice Committee is required. These orders are predetermined collections of set algorithms initiated based upon nursing assessment of the patient and are consistent with high-quality evidence based care, enhanced patient safety, and satisfaction.

[toomuchbaloney]

Seems like RNs do this sort of thing in a variety of settings already with standing protocols and orders for very specific circumstances.

In my view this enables the RN to initiate timely and appropriate care while remaining compliant the requirments of our licensure.

[OldDude]

We don't call them NIOs but we do this at the pedi urgent care where I am a pool nurse; an extension of the hospital. Our ER has always had a fever protocol, even when I worked there 18 years ago. We just recently started with administration of antipyretics, strep, flu, and rsv testing, UAs, and extremity x-rays prior to the patient being seen by the physician or NP by way of standing orders/instructions under supervision of the medical director. All of these interventions must be co-signed by the provider before the EMR can be closed for that visit. This did not originate as a result of the managementesque background description you indicated above but simply as a result of a new medical director who has finally listened to us - trying to reduce patient turnaround time. I've worked at this place 10 years and other nurses and I have constantly complained and asked for these options. Our clinic is open 5 hours during the week, 5p to 10p, and 9 hours on Sat and Sun, 1p to 10p. During this time of year we regularly see 60 to 70 patients during weekdays and will see 80 to over 100 patients on the weekend. These protocols can easily cut 30 to 60 minutes (or more) out of a clinic visit. If you want to get into more particulars about it, you can PM me an email address and I can contact you.