standing orders in your hospital

Nurses General Nursing

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I work in a small community hospital. Currently we have no standing orders, so if a patient developes a fever and has no order for Tylenol (and it does happen), we have to call physician at 2am for an order. I am trying to come up with a list of standing orders to present to the medical committee to have approved for standing orders (for adults). If anyone has any suggestions, it would be appreciated.

Thanks,

Kristy

Specializes in nursery, L and D.

Not adult care here, but a good idea, we have CBC-D and blood cultures ordered under certain circumstances.

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Specializes in Utilization Management.

Yeah, if I have a patient with a fever of over 100.4, I'm not just going to be asking for Tylenol; I'll want Blood cultures at least, too. Since I'm at it, will the doc want to start antibiotics after the BCs are drawn?

I usually go over the labs carefully and it's pretty rare that I have to call a doc for just tylenol. Even if I do call for Tylenol, I'll ask for parameters for blood cultures just in case.

You just can't catch a case of sepsis too quick, KWIM?

I'm guessing that you're talking about medical patients more than surgical here, because most of our surgeons do have standing postop orders, and our PCA medications automatically have standing orders that go with them, such as q4h vs, an antiemetic, an anti-itch and things like that.

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Specializes in Emergency.
If the docs don't order things like Tylenol, they deserve to be called at 2 a.m. You'd think they'd remember after one middle of the night call for such a small yet important matter.

I agree with Trudy.

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I have to agree with Trudy as well - sorry.

Our standing orders for m/s patients include K-pad for comfort, tylenol, MOM, Mylanta. Our Labor POS (personal order sets) allow us to start and run IVF at RN discretion or for certain criteria (VBACs, Para 4 or greater, etc), O2 at RN discretion, some allow Demerol or Nubain in Labor without a phone call first, Mylanta or Bicitra.

If I had to call for permission to start an IV everytime, I think I would go crazy.

Our hospital also has a policy on measures nurses can take without orders such as O2 if certain criteria are met (hgb 9.0 or less, o2 sat 93% or less, etc), Chemstrip, some labs, IVs, some meds in emergency situations.

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

Suggestion to the OP.

Contact some nearby hospitals & ask them to fax over copies of their standing orders.

Or just ask the experienced nurses of the orders they're used to writing routinely.

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Is Senna S a safe constipation method to use on someone who has dementia? I crush the pill and give it to her with food since she no longer likes to swallow pills. Please let me know what doctors are perscribing.

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I love the idea of acidophilus for antibiotics! do it at home but never thought of it at work. but what is TAO for skin tears, the abbrev just isn't ringing a bell.

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Specializes in Intensive Care and Cardiology.

TAO = Triple Antibiotic Ointment

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Thank you! ( feeling dumb right now)

The first hospital I worked at had a protocol for skin tears. It was a special product, pink, thick, kinda like a duoderm but different. it was held in place w/stockinette

Can anyone help me remember the name of this product?

We need a different method of dealing w/skins tears at our hosp. Too many nurses sticking opsite on them. works fine until you try to take the blasted thing off!

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Specializes in NICU.

are u thinking of allyven?

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.

Only three standing orders. Tylenol, MOM, and maalox.

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In addition to the other meds mentioned here, we have:

  • Benadryl 12.5 mg PO/IV for itching q 4-6 hours, may repeat x1
  • Zofran 4 mg PO/IV one dose only
  • orificeol
  • Blistex
  • Dulcolax
  • Potassium replacement
  • Mag and phos replacement for renal pts on CRRT (ICU only)
  • NS bolus (up to a liter, ICU only)

Per our ICU protocol we can

  • Draw a potassium, mag, phos, ionized calcium, H & H, ck-mb, troponin, type and cross, ABG if we feel the need.
  • Order a chest x-ray
  • Place a Foley
  • Place an NG
  • Hemoccult stool
  • Send a UA
  • Send a stool specimen to test for C-diff

As for a temp, our protocol is that we call any new onset temp, we can give Tylenol per protocol for a temp greater than 101.5, and do blood cultures when there is a temp of 101.9 or greater. The problem we run into with Tylenol is that there are certain docs who don't want you to use if for a temp, but then get grumpy when you call them because the pts heart rate is 125.

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