Standing Orders
These standing orders are approved by the medical director and providers of Community
Health Care, Inc. Appropriate staff Medical Assistants (MA’s), and/or, Licensed Practical
Nurses (LPN’s) and/or Registered Nurses (RN’s) who have been appropriately trained with
documented competencies may initiate these orders.
Urine Analysis
Appropriate Staff: MA’s, LPN’s and RN’s
Applicable Departments: Family Practice, Pediatrics and Obstetrics
Order: Pregnant women
Appropriate staff is authorized to obtain a routine UA on all pregnant women
Order: All patients
Appropriate staff is authorized to obtain a UA on patients with the following:
Patient presents with one or more of following symptoms:
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Pain or burning with urination
Frequent or urgent need to urinate
Cloudy urine
Blood in the urine
Foul or strong urine odor
Need to urinate at night
Patient may also complain of:
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Pressure in lower pelvis
Fever
Chills
Lower back or flank pain
Documentation: Appropriate staff will indicate on the encounter the UA was performed
Rapid Strep Test
Appropriate Staff: MA’s , LPN’s and RN’s
Applicable Departments: Family Practice, Pediatrics and Obstetrics
Order: Appropriate staff is authorized to obtain a rapid strep test on patients with the following:
Patient presents with two or more of the following:
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Sore throat
Tonsils that appear red with white or yellow spots at the back of the throat
Fever of 101 F(38.3 C) or higher
Pain and difficulty swallowing
Swollen lymph nodes in neck
Other symptoms:
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Headache
Weakness
Loss of appetite
Documentation: Appropriate staff will indicate on the encounter the rapid strep was performed
HbA1c
Appropriate Staff: MA’s, LPN’s and RN’s
Applicable Departments: Family Practice and Obstetrics
Order: Appropriate staff is authorized to perform a finger stick HbA1c on a patient with diabetes who’s most recent
HbA1c is more than 90 days old.
Documentation: Appropriate staff will document HbA1c on the encounter
Glucose
Appropriate Staff: MA’s, LPN’s, RN’s
Applicable Departments: Family Practice, Pediatrics and Obstetrics
Order: RN’s will perform finger stick Glucose on patients’ with symptoms of hyperglycemia or hypoglycemia. MA’s,
LPN’s, RN’s are authorized to perform a finger stick Glucose on any patient with diabetes.
Documentation: Appropriate staff will document glucose testing performed on encounter
Lead Screening
Appropriate Staff: MA’s , LPN’s and RN’s
Applicable Departments: Pediatrics
Order: Appropriate staff is authorized to obtain a lead screening on patients without a documented lead screening at
12, 18 and 24 months and again at 3, 4 and 5 years.
Documentation: Appropriate staff will document lead screening ordered on the encounter and send the patient to the
lab.
Reflexed Urine Culture and Sensitivity
Appropriate Staff: Laboratory Staff
Applicable Departments: All
Order: Reflex urine culture will be done when one or more urinalysis results are present.
Dipstick result:
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Nitrite: Positive
Leukocyte Esterase: Moderate or Large
Microscopic Exam:
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WBC’s: 5 to 10 or greater
Bacteria: Moderate or Many
Emergency Medication Administration
Appropriate Staff: RN’s
Applicable Departments: Family Practice
Order: Emergency medications may be administered when a patient presents with intense pain or uncomfortable
pressure in the middle of his/her chest; lasting longer than 1 minute and is accompanied with one or more of the
following symptoms:
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Squeezing chest pain (substernal/left side)
Sweating and nausea
Severe shortness of breath
Medication to be administered in the following order:
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Oxygen per nasal cannula 2 to 4 liters as needed
Administer Nitro 0.4mg sublingual; 1 every 5 minutes for unrelieved chest pain (total doses 3) only if systolic
blood pressure is > 100 mm Hg
o Nurse/provider will evaluate if additional outside emergency assistance is needed.
ASA 81 mg 4 chewable tabs
o Prior to administration nurse will identify any allergies or contraindications
Documentation: Appropriate staff will document outcome of emergency situation in the patients chart.
These standing orders are reviewed and revised annually if necessary. I authorize appropriate staff to perform the
above standing orders.
Medical Director Signature: ______________________________
Date: _____________