Open Forum

Good day all,

No judgement here, but I just want to gauge what is the cultural norm is or what should be the standard of who places orders for procedural areas at your ambulatory care sites? 

For this context, I am mostly thinking about sedation or non-sedation cases in a clean or sterile procedural suite. The orders involved can be anything from IV starts, IV fluids, meds, vitals, discharge criteria, and etc. 

I have worked in two outpatient procedural suites in two FQHCs, one has the physician do them all and another has nursing do them all. What about your areas? 

Thanks for the help!

Kevin

Good day all,

No judgement here, but I just want to gauge what is the cultural norm is or what should be the standard of who places orders for procedural areas at your ambulatory care sites? 

For this context, I am mostly thinking about sedation or non-sedation cases in a clean or sterile procedural suite. The orders involved can be anything from IV starts, IV fluids, meds, vitals, discharge criteria, and etc. 

I have worked in two outpatient procedural suites in two FQHCs, one has the physician do them all and another has nursing do them all. What about your areas? 

Thanks for the help!

Kevin

From a regulatory standpoint, if the nurse places the order she/he is practicing medicine without a license. I look for complete orders including IV fluid amount, rate etc...Many ambulatory sites do have standing orders, but they must be signed and approved by the governing body.  I have cited many a site for incorrect orders as it is outside scope of practice. I have also seen RN using Lidocaine prior to IV insertion with no order as well as multi patient use for single vial. This is also a citation. I have seen order sheets with  D5W, RL or NS and the nurse decides which one---which is outside scope. Hope that helps. 

Good day all,

No judgement here, but I just want to gauge what is the cultural norm is or what should be the standard of who places orders for procedural areas at your ambulatory care sites? 

For this context, I am mostly thinking about sedation or non-sedation cases in a clean or sterile procedural suite. The orders involved can be anything from IV starts, IV fluids, meds, vitals, discharge criteria, and etc. 

I have worked in two outpatient procedural suites in two FQHCs, one has the physician do them all and another has nursing do them all. What about your areas? 

Thanks for the help!

Kevin

You seem to have seen many procedure units and your insight is awesome. What would you say is the cultural norm? Based on what you just said I foresee three situations as would be the most common. Also amongst the three would you (or anyone else) think is best practice? 

1. A site has an approved standing order and nursing places orders.
2. Nursing places orders without an approved standing order, which is outside of a RN's scope of practice. 
3. Providers like APPs or physicians place the orders.

From a regulatory standpoint, if the nurse places the order she/he is practicing medicine without a license. I look for complete orders including IV fluid amount, rate etc...Many ambulatory sites do have standing orders, but they must be signed and approved by the governing body.  I have cited many a site for incorrect orders as it is outside scope of practice. I have also seen RN using Lidocaine prior to IV insertion with no order as well as multi patient use for single vial. This is also a citation. I have seen order sheets with  D5W, RL or NS and the nurse decides which one---which is outside scope. Hope that helps. 

Good day all,

No judgement here, but I just want to gauge what is the cultural norm is or what should be the standard of who places orders for procedural areas at your ambulatory care sites? 

For this context, I am mostly thinking about sedation or non-sedation cases in a clean or sterile procedural suite. The orders involved can be anything from IV starts, IV fluids, meds, vitals, discharge criteria, and etc. 

I have worked in two outpatient procedural suites in two FQHCs, one has the physician do them all and another has nursing do them all. What about your areas? 

Thanks for the help!

Kevin

You seem to have seen many procedure units and your insight is awesome. What would you say is the cultural norm? Based on what you just said I foresee three situations as would be the most common. Also amongst the three would you (or anyone else) think is best practice? 

1. A site has an approved standing order and nursing places orders.
2. Nursing places orders without an approved standing order, which is outside of a RN's scope of practice. 
3. Providers like APPs or physicians place the orders.

From a regulatory standpoint, if the nurse places the order she/he is practicing medicine without a license. I look for complete orders including IV fluid amount, rate etc...Many ambulatory sites do have standing orders, but they must be signed and approved by the governing body.  I have cited many a site for incorrect orders as it is outside scope of practice. I have also seen RN using Lidocaine prior to IV insertion with no order as well as multi patient use for single vial. This is also a citation. I have seen order sheets with  D5W, RL or NS and the nurse decides which one---which is outside scope. Hope that helps. 

Good day all,

No judgement here, but I just want to gauge what is the cultural norm is or what should be the standard of who places orders for procedural areas at your ambulatory care sites? 

For this context, I am mostly thinking about sedation or non-sedation cases in a clean or sterile procedural suite. The orders involved can be anything from IV starts, IV fluids, meds, vitals, discharge criteria, and etc. 

I have worked in two outpatient procedural suites in two FQHCs, one has the physician do them all and another has nursing do them all. What about your areas? 

Thanks for the help!

Kevin