PHYSICIAN STANDING ORDERS
PCP/NP is to be notified of initiation of Standing Orders by telephone order.
Admission Injections:
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PPD series x2 per package instructions, unless indicated otherwise, DC after 7 days
CXR if current PPD is Positive or if history of Positive PPD
Pneumovac per package instructions, if have not received within the last 5 years, unless
given after age of 65, DC after 7 days
Annual Flu Vaccine per package instructions, DC after 7 days
Bowel Management:
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Facility Bowel Protocol: implement only after no BM in 3 days
Step 1: If no BM for 3 days administer: SENNA 8.6mg TAKE 2 TABS PO QD PRN. If
no results see Step 2.
Step 2: If no BM from Step 1 give: GLYCERIN SUPPOSITORY: 1 SUPP PR QD PRN.
If no results see step 3
Step 3: If no BM from Step 2 administer DULCOLAX 10mg SUPPOSITORY: PR QD
PRN
Step 4: If no BM from previous steps of Oral Meds or Suppositories have not produced
results, the Charge Nurse will assess the resident status (check abdomen, bowel tones,
digital exam) and notify physician.
Capillary Blood Glucose (CBG):
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Follow facility Hypoglycemic & Hyperglycemic Protocols
CBG checks PRN for s/sx of hypo/hyperglycemia
For ALL Checks - If CBG is less than 60 or greater than 400 - Notify PCP
Notify PCP if CBG is greater than 300 for 3 consecutive readings (Notify by phone after
hours ONLY if resident is symptomatic. If not symptomatic, notify next day by SBAR
communication form to update on condition)
For CBG less than 60 symptomatic - Give Glucagon 1mg SC/IM xl, notify PCP, and then
reassess CBG in 45 mins
If resident is NPO and is receiving Lantus or Humalog Insulin - Cut Lantus dose in ½ the
night that the resident is NPO at Midnight and do NOT give Novolog or Humalog Insulin
that night or the morning of being NPO
Standing Orders Page 1
CHF Residents:
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Diet=NAS
Daily Weights - If weight is up more than 3lbs in 24 hrs, notify PCP. If weight up 5 lbs in
a week notify PCP.
Coumadin Protocols:
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May use facility PT/INR machine for testing unless resident is receiving a combination of
Lovenox/Heparin & Coumadin
If resident is on Lovenox & Coumadin - lab must be drawn by lab service
No in-house INR testing while on Lovenox
Target INR 2.0-3.0 for Atrial Fibrillation, DVT
Target INR 2.5-3.5 for Mechanical Heart Valve Replacement
If resident is admitted with Coumadin orders, but does NOT have INR orders - check
INR next day
Notify Provider of INR value when available
Diabetic Residents:
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Initiate CBG check Four Times Daily (Before meals & at bedtime) if on insulin and in 5
days, give copy of CBG log to attending provider
Check fasting CBG x 5 days if on oral antidiabetics and in 5 days, give copy of CBG log
to attending provider
HOLD Humalog/Regular/Novolog Insulins for CBG less than 60
Ear Protocol:
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LN to check ears on pt request & PRN
If Cerumen is present - Debrox drops GV protocol may be initiated
GI Medications: only start if complaining of indigestion
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House Stock Antacid: Take 30 ml PO Q2H PRN Heartburn (Do NOT give if there is
diagnosis of Renal Disease)
If unresolved with house antacid or has renal disease: Tums 500 mg (House Stock): Take
2 tabs PO Q4H PRN Indigestion
Standing Orders Page 2
Intravenous (IV's):
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Follow Pharmacy protocols for IV Maintenance
Flush IV w/10cc NS pre & post med administration Inspect IV site QSHIFT
Change IV insertion site Q5days
Change IV tubing Q24hrs
Change PICC dressing and cap weekly
Measure length of exposed cath from exit site to hub (in inches) QWeek
Measure mid-arm circumference to monitor for phlebitis QWeek
Lab Work (Residents on the following meds will have lab work done as indicated below):
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Anticoagulants - PT/INR Monthly or as Directed
Pain (Analgesics):
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Tylenol 325mg: Take 2 tabs (650mg) PO Q4H PRN for Pain or Fever ***NTE 3250mg
per Day*** (Do NOT give if allergic or has diagnosis of liver disease). Must notify
provider if started.
Cold: Ice/Polar Pack/Cryotherapy- Apply to affected area x15-20 min as tolerated PRN
QID Pain
Heat: Thermotherapy/Moist Hot Packs- Apply to affected area xl 5-20 min as tolerated
PRN QID Pain
Skin Protocols:
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ALL Skin Issues/Incisions: Notify provider, monitor site QD until resolved, Notify MD
for any s/sx of infection
Skin Tears: Cleanse w/NS, pat dry, if able to approx. edges - steri-strip, if unable to
approx. edges - cover w/clean dry gentle border drsg. Monitor QD and Change PRN until
resolved.
Pressure Ulcers Stage I: Apply barrier cream QSHIFT & PRN. Apply padded drsg.
Pressure Ulcer Stage II: Cleanse w/NS, pat dry, and apply foam drsg. Notify provider for
further instructions. Change QD & PRN
Infected Wounds: Cleanse w/NS, pat dry, and apply clean dry drsg. Then notify PCP for
further instruction
Standing Orders Page 3
Urinary Retention:
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Bladder Scan if s/sx of urinary retention or 8 hrs w/o urination
Straight Cath for >300 cc & Notify PCP
For ALL Foley Catheters:
o Change FC QMonth & PRN
o DOCUMENT FOLEY CATH CHANGE, URINE APPEARANCE, OUTPUT,
COLOR, AND CATHETER SIZE IN NURSES NOTES. REPORT TO MD ANY
UNUSUAL FINDINGS*
o Change FC Bag QMonth & PRN Blockage
Other:
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BP parameters -HOLD Antihypertensive meds if Systolic BP is Less than 100 or Pulse
Less than 45 & Notify Provider
If Systolic BP is Greater than 170 or Less than 100 - Repeat BP check using a manual
cuff. If SBP remains significantly abnormal - Notify Provider
If notice trends (BP either excessively higher or lower for 3 days in a week) - Notify
Provider
Beta Blockers - HOLD for Systolic BP Less than 90 or Pulse Less than 45 & Notify
Provider
Ok to crush medications per Pharmacy protocols
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Medical Director
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Date
Standing Orders Page 4