Policy ID: SO

Version 1.0

Date: 09/02/2017

Reviewed:  27/06/2023

Purpose:

• To ensure the safe use of Standing Orders within our practice
• To enable the timely access to medications for our patients.
• To help ensure that all members of the team are working at an appropriate and consistent level of competence and confidence within their scope and level of experience.

Responsible Staff:

Implementation: Clinical Director

Action: Clinical Staff, Quality Administrator

Audit: Clinical Director

Audit:

Training Resources:

There is a suite of centrally maintained training resources available for staff on healthpathways (search standing orders)

Linked Policies:

Individual Standing Orders may be considered to be linked to this policy

Policy:

The registered medical practitioner providing ongoing care of the patient is ultimately responsible for the Standing Order.

The Clinical Director shall be responsible for assessing the competence of Registered Nurses for each Standing Order.  No standing order may be used unless the specific Registered Nurse has been approved as competent by the Clinical Director, or appropriately appointed deputy thereto.

The use of standing orders shall be incorporated into the induction of any new reception, nursing or medical staff.

The standard of labelling, storage and other medication–related advice given with medicines supplied under a Standing Order should meet the expected level provided should the medicine otherwise have been dispensed at a pharmacy.

Standing Orders shall apply only when a registered medical practitioner is not available to provide a prescription for medication.  This may include times when a registered medical practitioner is in the building but is otherwise engaged in clinical duties.

Where the patient is to remove medication from the practice, the medication may only be dispensed in the pre-labelled packages provided.

Training and Competence to use Standing Orders

Registered nurses who dispense medication under a Standing Order must understand that they are responsible for assessing the patient and ensuring that the medication is only dispensed in accordance with the provisions of the Standing Order.

Each Standing Order will describe the level of training and competence expected, including how this is to be assessed.  This includes but may not be limited to Healthlearn on Healthpathways.

Before any medication may be issued under a Standing Order, the Registered Nurse must ensure that the Clinical Director has signed the appropriate Competence Register for that particular nurse and that particular Standing Order.

The Quality Administrator shall be responsible for ensuring that the Competence Register is maintained appropriately.

Standing Orders

The text of each standing order approved for use shall be maintained on this website.  The version on Healthpathways may differ but the version on this practice site shall be the one which is approved.

Every time a registered nurse supplies or administers medications using a Standing Order, they will make a summary of the consultation including any adverse reactions in the computerised daily record of the patient and in addition to the specific information required by the Standing Order:

• Details of the history of the presenting problem described by the patient
• The assessment carried out including examination and investigations
• The working diagnosis
• The medication provided (including dose, route of administration and quantity)
• Any other treatment provided
• Arrangements made for ongoing monitoring and follow up, (which may or may not include scheduling  a follow-up appointment with a GP)
• The name of the Standing Order under which the treatment was provided.

For casual patients, where medical history is not available, it is also necessary to include:

• Past medical history (in so far as it may be relevant to the condition being treated)
• Allergies
• Current medications

In order to facilitate identification of which consultations have involved use of a standing order, the registered nurse shall enter a screening entity of SO, specifying which standing order has been used.

Countersignature

Where it is specified in a Standing Order that a countersignature is required, it shall be sufficient that the registered medical practitioner approached for the countersignature shall make a suitable entry about the matter in the clinical records.  A formal signature on paper shall not be required.

Adverse Events

If an adverse event occurs, this shall be handled in accordance with our Significant Incident Policy.  In addition, the registered nurse involved MUST NOT issue further medication under standing order until the Clinical Director has given approval.

We recognise that most adverse events will not be the result of any staff failing, but patient safety is our priority.

Review of Standing Orders

Standing orders shall be reviewed every three years, or sooner if changes are advised as a result of changes in Healthpathways.

Appendix 1

Standing orders currently implemented at Sumner Health Centre:

Depo Provera

Emergency Contraception

Female UTI

Vulvovaginal Candidasis

Paracetamol

Ibuprofen

Warfarin Dosing

Conjunctivitis

Chlamydia

Otitis Media

Lidocaine/Lignocaine 1 or 2% for anaesthesia.

Review Log

27/06/2023 - no changes required.