standing orders

Published

  • Specializes in L&D, school nursing. Has 14 years experience.

Do you have standing orders at your school/district? If so, what are they for? We have been discussing this for common items such as hydrocortisone, Tums, ibuprofen, etc. but I'd love to get some feedback from others first.

Farawyn

12,646 Posts

Has 25 years experience.

Not really. We are trying to get for TUMS, saline drops and hydrocortisone.

Specializes in School nursing.

We do. Ibuprofen, Acetaminophen, Tums, hydrocortisone cream, Benadryl (as part of allergy action plan, not for seasonal allergies), cough drops (yep, need an order for those), Oragel, Robitussin (12+ only), and petrolatum jelly.

I just helped update these for our new school physician to review. So. much. paperwork.

And documentation. But may also mean getting new standing orders for Epi-pens - finally!

kayakqueen

17 Posts

Specializes in L&D, school nursing. Has 14 years experience.
We do. Ibuprofen, Acetaminophen, Tums, hydrocortisone cream, Benadryl (as part of allergy action plan, not for seasonal allergies), cough drops (yep, need an order for those), Oragel, Robitussin (12+ only), and petrolatum jelly.

Could you possibly elaborate on how detailed these orders are and the paperwork involved? Did you already have a school physician in place (we don't have one)? And a standing order for Vaseline?? I don't think of that as "medicine". Thanks for your feedback!

DEgalRN

454 Posts

I have standing orders for allergic reactions (benadryl and epi-pens), and narcan, but I don't have narcan to give. I'd like orders for saline drops, but I don't think that will happen. I have parental permission for antacids, tylenol, and advil, so I don't need standing orders for those.

Specializes in School nursing.
Could you possibly elaborate on how detailed these orders are and the paperwork involved? Did you already have a school physician in place (we don't have one)? And a standing order for Vaseline?? I don't think of that as "medicine". Thanks for your feedback!

I don't think of cough drops as medicine, really, either ;).

We have an order because of infection control and knowledge it may be used. Cover all bases, I suppose. Every district is different, however, and state protocols may be different. Public school in my state need OTC orders and parental permission in order to give OTC meds. Which meds can be given are determined by district.

We were between physicians and are transitioning into a new one. Each med has an order, roughly a page, detailing: dosage ranges by age/weight, indications it can be given for, contraindications, and possible adverse reactions. Then there is a short nursing protocol to follow when giving the meds - must have written parental permission or one-time only verbal permission, must have complete allergy history of student prior to administration, must reassess student as needed for any follow-up care.

I have a standing order from our school dr for epi pens (non patient specific, only can be administered by RNs employed by the district) and we have an OTC form that parents and a child's physician check off which items I have permission to use as needed in the Health Office. Both the parent and the physician need to sign the form. This is used for cough drops, Neosporin, Tylenol, anbesol, saline drops, etc. In my state these can only be used with permission from both the parent and the physician so I get these on file at the beginning of the year so we are prepared when the time comes. I usually get about 1/2 back in my school. The rest of the kids can't have any of this.

NanaPoo

762 Posts

Specializes in School Nursing, Hospice,Med-Surg. Has 18 years experience.

We are a private school. Each student has a health info card where a parent checks off in August "yes" or "no" to the following meds:

Acetaminophen

Antihistamines

Ibuprofen

Decongestants

Topical Ointment/Lotion

Tums/Mylanta

This allows me to be pretty free and allows me to choose the dose in regards to weight and severity of symptoms. I always notify parents when I medicate a student and let them know the dosage amount and how I came to that amount. OR if a parent has marked NO on a med that I think the student could really use, I will call home and request it and 99% of the time the parent will ask for me to give it at that point.

bell1962

345 Posts

Specializes in family practice and school nursing. Has 30 plus years experience.

Just for non patient specific epinephrine. Everything else needs parent permission and Drs orders.

SassyTachyRN

408 Posts

Specializes in Peds, Oncology. Has 4 years experience.

Epi/Benadryl for anaphylaxis and albuterol for respiratory distress.

coughdrop.2.go, BSN, RN

1 Article; 709 Posts

Specializes in School Nursing, Public Health Nurse. Has 3 years experience.

Yes we have standing orders. I have a binder with my nursing protocols and they are updated and signed by our NP. I have everything from Ibuprofen/Acetaminophen to Epi pens. Muscle rub cream, Benadryl, Loratadine, Oragel, Cough syrup/drops, eye drops, hydrocortisone cream, triple antibiotic, and others.

OldDude

1 Article; 4,787 Posts

Specializes in Pediatrics Retired.

I wish we had a medical director.