CS-239

Issue Date: 02/25/2011

Effective Date: 02/25/2011

Last Review or Revision Date: 01/10/2012

Policy Name: / Originating Department
Standing Treatment Orders for RNs and LPNs
Laws, Regulations or Standards Associated With This Policy:
Related Policies:
Related Attachments:
Board approved: 2-25-11
Policy Type:
New / Revision /  Replacement (specify):

POLICY:

This policy describes the criteria under which a staff RN or LPN may administer certain treatments to health center patients without requiring an order from a provider.

PURPOSE:

The purpose of this policy is to improve patient flow, decrease wait time for both staff and patients, increase patient care quality and patient satisfaction.

PROCEDURE:

Standing orders are orders that can be executed by a RN or LPN if a patient or medical condition of a patient meets certain criteria. Criteria will be established using the published guidelines of standard care governing bodies such as AAFP, AAP, National health guidelines regulations committees, and the policies and expectations set forth in the grants which fund the CAA health and dental centers.

Standing orders include but are not limited to:

  1. Routine/updated Tdap/td for adults
  2. Routine/updated seasonal flu vaccines for adults and children
  3. Routine/updated pneumococcal vaccines
  4. Diabetic foot exams
  5. Yearly EKGs on any patient who has a diagnosis of hypertension
  6. All criteria that are part of the diabetic and hypertensive collaborative studies
  7. Instruct and dispense take home stool guaics annually
  8. Make a referral appointment for:
  1. Yearly/routine dental appointment for adults and children
  2. Yearly dilated eye exams especially for all diabetic patients
  3. Colonoscopies
  4. Mammograms
  5. Pap smears or pelvic
  6. Well child exams on a yearly basis
  7. Smoking Cessation
  1. Routine childhood immunizations are to be reviewed at every office visit regardless of the reason for visit and the appropriate immunizations given unless contraindicated. If childhood immunizations are not given for any reason, an immunization visit is to be scheduled for that patient. See policy #CS-238, immunization standing orders.
  2. Proper documentation of the standing order is critical and must be done at the time of the execution of the order. Proper documentation is to be recorded on the flow sheet, progress note and immunization record (or related electronic document) within the patient record. Immunizations must be entered into the state tracking system (IMPACTSIIS) when the vaccine is given. Proper documentation includes:
  1. The date
  2. The lot# of the vaccine
  3. The site on the patient where the vaccine is placed
  4. The expiration date of the vaccine
  5. The current vaccine information sheet date on all pediatric vaccines
  6. The result, when relevant (i.e, normal or abnormal for EKG, urine, etc.)
  7. The name/initials of the RN or LPN executing the order (must be legible)
  1. If any result is abnormal, the result must be given to the appropriate provider. That provider is to co-sign and arrange for appropriate follow-up. If the provider is not available, the result is to be given to the charge nurse/site supervisor. An abnormal result is not to be filed unless it has been seen and co-signed by the provider.
  2. The charge nurse and/or site supervisor is responsible to be sure all RNs and LPNs have a copy of the guidelines that are to be followed before executing any standing order.
  3. If a RNor LPN does not have a copy of the guidelines or if they are unsure in any manner of what should be done, they are not to execute the order. They are to first seek clarification from the charge nurse/site supervisor or the appropriate provider. If none of these people are available the standing order should not be executed. NOTE: guidelines change; the RN or LPN administering the standing order is responsible to know the latest applicable guidelines.
  4. It is ultimately the responsibility of the RN or LPN to be absolutely sure of what procedure is to be followed, whether the patient meets the stated criteria, and to provide proper documentation.

Exception Process: There are no exceptions.

Monitoring: Will be at the discretion of the Quality Committee.

Beth Weir, COO
Signature: / Name
Chief Operating Officer / Date:
David Cola, D.O.
Signature: / Name
Medical Director / Date:
Sandy Gruszecki, RN
Signature: / Name
Charge Nurse / Date:

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