Good morning,
I think there is a time and a place for standing orders. I have some concerns and like to approach problems from a position of knowledge and understanding.
The first question:
What problem are we trying to solve? Why does the problem exist and how long has it been a problem? What are the risks to this problem?
What are ALL the potential solutions with pro's & con's? Etcetera.
Until we completely understand the problem, any solution we find and attempt to implement may increase the likelihood of unintended consequences. For those who are creating standing orders I'd like to hear more about the problem you are experiencing that leads you to believe this is the best solution. What pitfalls have you mitigated? What unintended consequences have you found?
I worry that simply have a standing order doesn't address the root cause of a problem, and, creates the potential for more problems. Creating a standing order that automates, limits, or eliminates clinical judgement seems, on the surface, to be a time saving process enhancer. However, we are dealing with real people with real concerns, feelings, preferences, and conditions. Is one-size-fit-all really the right way to go? Additionally, if an LPN has a directed scope of practice, can an LPN initiate a standing order independently? Is that potentially a NPA violation?
While I have a number of additional questions and concerns, I will leave my comments with this: if the standing order is "the" way to go to fix your problem, what prevents you from having an ordering kiosk where the patient can self select their "order". If no or limited clinical judgement is needed (i.e. no assessment) why is a nurse needed?
Maria Burke
-- Maria
Maria S. Burke, BSN, RN-BC, AE-C
District 1199NM
505-948-2043
Original Message:
Sent: 8/3/2023 8:23:00 AM
From: Andrea Kelly
Subject: RE: Nurse Initiated Orders
Once again, I agree with Torie!
We have different sets of standing orders, depending on the patient population (pediatrics, general medicine, women's, urology, cardiology). The orders are based off of best practices, commonly ordered tests, published vaccine standing orders, and for population health specific items the US Preventative Task Force standards. Commonly ordered tests have clear indications on when it can be used (ex: rapid strep can be performed if the patient is presenting with acute onset of sore throat with fever).
The goal for all of these is to have a standard that requires no critical thinking or medical judgement.
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Andrea Kelly MSN, RN, NPD-BC
Director, Population Health
ECU Health Physicians (formerly Vidant Medical Group)
Greenville NC
(252)847-3930
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