Standing Orders
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Policy
All details about each standing order should be included in the signed document. This includes who is authorised to use it, the procedure to follow, and the countersign/audit requirement.
At our practice, registered nurses (without prescribing rights) who are authorised under standing orders, may administer and/or supply medicines from our supply (pre-packaged and labelled), to patients. Using standing orders improves access to medicines in specific situations.
Standing orders processes must be followed closely and comply with:
Standing order use is included in the induction and orientation of clinical staff.
For all medication issued under a standing order, the nurse records details of the 
consultation and medication/s supplied in the patient record.
We document details of each standing order. All standing order documentation is managed by the lead nurse.
Standing orders are reviewed annually, or if something changes.
Our authorised standing orders are stored in GPDocs at the bottom of this page, with a hard copy also kept at the practice.
We use tasks and codes in Medtech to identify when standing orders have been used so they can be approved, countersigned, and/or audited by the issuer.
If there is an adverse event or near miss from medicine administered under standing order, manage and report it according to the practice's Adverse Events policy.
Issuing
Standing orders must have a single issuer. The standing order must clearly state the issuer's name. The named issuer is responsible for meeting the legal requirements of a standing order. and determines whether the standing order must be audited or countersigned.
If the issuer leaves the practice, a new standing order must be created.
Training and competency
Nurses are trained and assessed as competent by the issuer before being authorised to use a standing order. The competency of each person working under a standing order is reviewed annually.
Staff training is completed online or in-house.
Nurses who supply medication under standing order accept responsibility, accountability, and legal liability for their clinical practice. This includes responsibility for:
- assessing the patient
- determining whether use of the standing order is indicated
- identifying ongoing monitoring and/or follow up.
If a nurse's competency using a standing order comes into question, the issuer is responsible for raising it with them and developing an appropriate mitigation strategy. The nurse's authorisation to use the standing order may be cancelled until they regain competency. This must be documented.
A standing order may be used by staff administering vaccines who do not have authorisation, or whose authorisation is pending.
See also Foundation Training.
Countersigning and Auditing
Each standing order must be either countersigned or audited. The countersign or audit requirement is decided by the issuer and is detailed in the standing order document.
Any issues identified during countersigning or the audit process should be addressed promptly.
Countersigning
Some standing orders may require countersigning.
The issuer of each standing order determines whether countersigning is required, and the timeframe it must be done in.
Auditing
Standing orders that do not need countersigning (or need countersigning less than once a month) must be audited.
In an audit, a sample of each standing order is checked by the issuer. Record audit results, as well as any changes or improvements needed.
Full audit requirements are detailed in the Ministry of Health's Standing Order Guidelines, (Section 10, para 26)
Annual review
The issuer reviews each standing order annually, or if something changes. The annual review can't be delegated and must be done by the named issuer (other people can help gather the information).
In an annual review:
- determine whether standing order is still needed
- update document if necessary
- sign and date standing order.
If information in a standing order is updated following review, the issuer communicates this to the authorised nurses and arranges additional training if needed. Obsolete standing orders should be replaced with the new versions.
Standing orders documentation for the practice
If you use standing orders, we can link to them here. |
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