standing orders

momcats3 · Nov 22, 2004

Hi there! I am fairly new to a fairly new Hospice. I am the patient care coordinator and am intrested in initiating some standing orders. Does anyone have some suggestions on getting started and some of the things in your standing orders? Thanks:)

We have MSIR and lorazepam liquid, Lorazepam tablets, Levsin tabs, ABHR suppositories, acetaminophen suppositories, and some separate Scop patches. PM me if you want the amts of ea.

:nurse:

jerseyRN · Nov 22, 2004

We have MSIR and lorazepam liquid, Lorazepam tablets, Levsin tabs, ABHR suppositories, acetaminophen suppositories, and some separate Scop patches. PM me if you want the amts of ea.

On admission we send each patient a "kit" containing emergency meds. But we get orders before using any of it. We don't have standing orders that apply to everybody.

webblarsk · Nov 22, 2004

On admission we send each patient a "kit" containing emergency meds. But we get orders before using any of it. We don't have standing orders that apply to everybody.

I like the idea of emergency packs, but do you end up wasting meds or are you able to reuse the items if not used. What all is put in the emergency packs?

webblarsk · Nov 22, 2004

On admission we send each patient a "kit" containing emergency meds. But we get orders before using any of it. We don't have standing orders that apply to everybody.

Thanks for the input

aimeee, BSN, RN · Nov 23, 2004

We have standing orders for everything that commonly arises...pain, nausea, dyspnea, constipation, terminal congestion, sleeplessness, hiccups...3 pages worth of standing orders with 3 or 4 alternatives for each symptom. Most of the doctors really like the standing orders because it means they aren't being called constantly. We nurses love them because it means we aren't helpless watching a patient suffer while waiting hours for the doctor to return a call or a page.

We also use the emergency kits. Yes, most of it is wasted but they are worth their weight in gold when you have need of them in the middle of the night. No, you can't reuse the meds, but they are actually pretty cost effective.

jerseyRN · Nov 23, 2004

It has 60 mg roxanol, 3 each compazine tabs/ compazine supps, 3 tylenol supps; 3 levsin tabs and three 1-mg lorazepam tabs. We often do wind up wasting the contents, or part of the contents.. But you can't put a price on having on hand what you need to make someone comfortable right away.

webblarsk · Nov 23, 2004

We have standing orders for everything that commonly arises...pain, nausea, dyspnea, constipation, terminal congestion, sleeplessness, hiccups...3 pages worth of standing orders with 3 or 4 alternatives for each symptom. Most of the doctors really like the standing orders because it means they aren't being called constantly. We nurses love them because it means we aren't helpless watching a patient suffer while waiting hours for the doctor to return a call or a page.
We also use the emergency kits. Yes, most of it is wasted but they are worth their weight in gold when you have need of them in the middle of the night. No, you can't reuse the meds, but they are actually pretty cost effective.

Thanks for the input. I am not really as concerned with the cost but curious how it works. I will spend whatever needs to be to make my patient comfortable. I think the emergency kits are a wonderful idea, I know I don't like the idea of waiting around on a Doc. Thanks for all the great info.

webblarsk · Nov 23, 2004

It has 60 mg roxanol, 3 each compazine tabs/ compazine supps, 3 tylenol supps; 3 levsin tabs and three 1-mg lorazepam tabs. We often do wind up wasting the contents, or part of the contents.. But you can't put a price on having on hand what you need to make someone comfortable right away.

Thanks for the wonderful information, like I said in previous post, i wasn't as concerned with the cost, just curious how it worked. I think the emergency kits are a wonderful idea. Do you use the same kit for each patient or tailor it to fit your patient and diagnosis.

aimeee, BSN, RN · Nov 23, 2004

The kits are supplied by a national hospice pharmacy supplier so they are standardized. If they have allergies you can have them ship the kit without certain items but you cannot substitute anything into it. Ours have less roxanol but more of the other items mentioned. In addition they have liquid haldol and ABHR suppositories. All of the items in the kit are in the standing orders.

webblarsk · Nov 23, 2004

The kits are supplied by a national hospice pharmacy supplier so they are standardized. If they have allergies you can have them ship the kit without certain items but you cannot substitute anything into it. Ours have less roxanol but more of the other items mentioned. In addition they have liquid haldol and ABHR suppositories. All of the items in the kit are in the standing orders.

Do you have any contact information you could share with me? Thanks so much.

Angelica · Nov 24, 2004

Are the ABHR supps for nausea? We use something similar, except we use haldol, benztropine, reglan and decadron. What does the 'A' stand for?