Issued: July 2013 Review date: July 2014
Medicine Standing Order Title: Ibuprofen
Rationale: In a rural GP clinic there are times when an authorised prescriber is not
available and in order for patients to access care a registered nurse using standing
orders is the best option.
Organisation/clinic: Church Street Surgery Opotiki
Scope: To enable registered nurses working in the clinic to treat patients with proven or
suspected pain and or fever.
Medicine/s: Ibuprofen (nurofen)
Dosage instructions for each medicine:
Patients aged 12 yrs and above.
200mg to 400mg 4-6 hrly (maximum of 3 doses in 24 hrs)
Adverse effects: GI disturbances; tinnitus; oedema/fluid retention; dizziness; headaches;
rash, pruritis; decreased appetite.
Rare: depression, insomnia.
Route of administration: Oral
Indication/circumstances for activating the standing order:
To treat patients with proven or probable pain and or fever in a rural GP clinic setting.
Precautions and exclusions that apply to this standing order:
Contraindications: Known hypersensitivity to ibuprofen, aspirin, other NSAIDS. Patients
with risk of GI ulceration/bleeding/haemorrhagic diathesis,
Precautions: Aspirin/NSAIDS induced asthma/rhinitis/urticarial/opthalaloical disturbances.
Systemic Lupus Erythrematosus. Renal/hepatic/cardiac impairment. Hypertension.
Cardiovascular disease and thrombotic event / risk of.
Drug interactions: ACE inhibitors, beta blockers, diuretics, lithium, anticoagulants, cardiac
glycosides
Persons authorised to administer the standing order:
Registered nurses.
Competency/training requirements for the person(s) authorised to administer:
Prior to administering medication under this standing order the registered nurse is required
to undergo the in-house training on the policy, procedure and documentation requirements
for this standing order. A record of this training will be kept.
Countersigning and audit:
Countersigning by the issuer is required within 7 days of use of this standing order.
Definition of terms used in standing order:
Additional information: Follow protocol as attached.
Signed by issuer:
Name:
Title: Medical Practitioner
Signed by Management:
Name:
Title:
Signed by Nurses working with Standing
Order:
Name/s :
Date:
Date:
Date:
This Medicine Standing Order is not valid after the review date.
Ibuprofen Policy
Nurses may administer ibuprofen for pain management according to the following
protocol:
1. Client history to be completed, including medical history, allergies and concomitant
medication.
2. All requests to obtain analgesic pain relief will be assessed fully and discussion
concerning health condition, fluid intake, stress, harmful effects of medication and
previous use will be discussed.
3. Fluid intake will be encouraged when clients present with headache/pain symptoms
(Fluids will not be given where a possible need for surgical intervention is assessed).
4. If vomiting, febrile, or there is a clinical concern, then client is to be referred to a GP.
5. The following will also be discussed and recorded in clinical notes;
 time of last dose of ibuprofen
 frequency, reason for use, dosage and time administered
Medication
 Ibupfrofen 200mg – 400mg (taken with water) every 8 hours; max 3 doses / 24 hours
6. Clinical notes are to be recorded on Medtech file.
7. Countersigning is to be completed by issuer (To be set for the doctor on Medtech)
Adolescent with fever or pain
fever < 40
pain not extreme
No symptoms suggesting meningitis.:
Vomiting, neck pain, rash, severe headache
No paracetamol containing meds in past 4
hrs
No ibuprofen containing meds in past 8
hours
fever > 40
pain extreme
Ass symptoms suggesting meningitis.
Vomiting, neck pain, rash, severe headache
Paracetamol containing meds in past 4 hrs
Ibuprofen containing meds in past 8 hours
Known allergy
No known allergy
Paracetamol 500mg - 1 gm single dose, plus
maximum of 4 gms in 24 hrs for one day
supplied. under SO.
OR
Ibupprofen 200mg - 400mg single dose, plus
max 3 doses in 24 hrs for one day. One dose
supplied under standing order
refer to GP