Standing Orders

 

Standing orders are to be used to improve patients’ timely access to medications in the primary health environment within the WellSouth Primary Health Network. Standing orders allow health professionals without prescribing rights to administer and/or supply medication for a specified medical condition.

The following information is sourced from the Ministry of Health Standing Order Guidelines (2016) 

 

Issuer

Only a medical practitioner or nurse practitioner is able to issue standing orders.

The issuer/s (i.e. Medical Practitioner or Nurse Practitioner) retain overall responsibility to:

  • Ensure legislative requirements are met.

  • Ensure anyone operating under the standing order has the appropriate training and competence to fulfil the role.

  • Countersign or audit the use of the standing order and review (at least annually) the standing order.

 

Working under standing orders

A person working under standing orders must have:

  • The training and competence to make an assessment that the standing order applies to the presenting patient.

  • The competency to administer and/or supply the medication.

  • The knowledge to assess the contraindications and/or exclusions to withhold treatment.

A standing order authorises supply and/or administration of a medication. It does not authorise generation of a prescription for a medication, nor does it authorise the use of pre-signed prescriptions for a medication.

Before providing medication under any standing order, check if the patient:

  • has a history of allergy or sensitivity to that medication.

  • is pregnant or breastfeeding.

  • is on any other interacting medication.

  • has cardiac, respiratory, renal, or hepatic disease.

  • is frail or elderly.

If there are any positive or unknown answers, consult a doctor, nurse practitioner or pharmacist.

 

Record keeping

It is important that if the issuer is auditing the standing order, they are able to see a full and complete record. For example the following should be recorded in the patients’ clinical record:

  • Any red flags excluded

  • Assessment of patient

  • No contraindications

  • Precautions are assessed

  • Medication supplied and/or administered

  • Monitoring

  • Follow-up

 

Countersigning or auditing of standing orders

Each practice must decide whether the standing orders will be countersigned or audited.

If countersigning is required, the period within which the issuer/s must countersign must be specified within the standing order.

If auditing the standing order, then this needs to occur at least monthly by the issuer and if more than one standing order is utilised over the preceding month, then a sample from each standing order will need to be audited.

Recommended sample size for auditing should be:

  • 50%: if 20 or fewer in total standing orders used

  • 20-30%: if the number of standing order used was between 21 and 100 

  • 15-20%: if more than 100 standing orders were used 

 

Medication

  • If using MedTech, then the medication needs to be prescribed in the nurses own name in the MedTech system, as the intent of the standing order is for the nurse to supply the medicine under the standing order.

  • Medicines to be administered and/or supplied, must be available on site.

  • If supplying medication, supply should come from stock supplied by a pharmacy and labelled specifically for this purpose. 

  • Standing orders do not cover nursing staff counting and labelling medications, as this is dispensing and is outside the scope of registered nurses. 

  • If at all possible provide a patient information leaflet or information on the medication. 

Practice Implementation

References  

These standing orders are not intended to be used as standalone documents. Staff who have been given training and are deemed competent to operate under these standing orders, should be familiar with and have access to other resources when working from these standing orders. Examples include, but are not limited to: