Protocol vs. Standing Order

[seahawksfanguy]

Someone please explain this simply for me!

[Sun0408, ASN, RN]

From my facility protocols are facility based set of orders that can be done without the MD's signature. Ex: Chest xray after intubation or KUB after NG tube placement.. Rapid response is ran with protocols..Nursing consults for wound care.

Standing orders are physician or practice specific and must be ok'd or signed by that physician before you can use them. Ex: Tylenol for fever, ambien for sleep, MOM for constipation..

[CraigB-RN, MSN, RN]

The definition is somewhat based on your state nurse practice act. In one state i know of, nurses follow standing orders and NP's follow protocols.

recently CMS has made some rulings on the subject Well recently as in 2008

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter09-10.pdf

[Esme12, ASN, BSN, RN]

Protocol means a series of actions (which may include a number of medications) that may be implemented to manage a patient’s clinical status. A protocol allows the application of specific interventions to be decided by the nurse based on the patient meeting certain criteria outlined in the protocol as long as the intervention is within the scope of practice of the nurse.

A protocol includes alternative actions or “exceptions” to the prescriptive orders that allows for individual patient circumstance as assessed by the nurse. These “exceptions” are addressed by application of an algorithm that is a step by step procedure for solving a problem or accomplishing the intervention.

An agency may, if it chooses, have protocols that are developed by authorized practitioners and are designed to standardize and optimize patient care in accordance with current clinical guidelines or standards of practice.

Standing orders means medical treatment orders generated by an authorized prescriber who identifies an action or medication that must be implemented or administered.

The use of standing orders must be documented as an order in the patient’s medical record and signed by the authorized practitioner responsible for the care of the patient, but the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances