Are you looking for a way to improve practice efficiency, provide consistent care to patients and empower your staff? If so, standing orders may be something to consider. Medication standing orders are written protocols, approved by a physician or board of physicians, who authorize qualified staff (where allowed by state law) to give medications under predefined conditions. In allergy/immunology, they’re commonly used for things like:
- Epinephrine for anaphylaxis
- Albuterol for acute symptoms
- Antihistamines after reactions
- Vaccines in some settings
Standing orders can make your clinic run smoother, provide faster response during emergencies, and ensure patients receive consistent care. They also provide clear protocols for nurses and medical assistants. However, there are several things you should address before implementing standing orders.
- Provide clear, detailed protocols. Include exact indications; medication, dose and route; contraindications; and when to escalate to a physician.
- Consider state scope of practice requirements. Check state rules on who can administer medications, required supervision and documentation standards.
- Ensure staff training and competency. New staff workflows require additional training. Be sure to supervise staff performing standing orders and protocols to ensure they’re done correctly.
- Provide physician oversight. Standing orders require physician approval and regular review/updates.
- Require good documentation. When using standing orders, always document why the condition was triggered, what was given and how the patient responded.
Here are a few sample standing orders provided by Immunize.org and the ACAAI Practice Management Committee. [1]
- Immunize.org Vaccine Standing Order Templates
- Albuterol, Levalbuterol or Albuterol/Ipratropium via nebulizer standing order
- Epinephrine 0.15 mg or 0.30 mg standing order
- Oral Antihistamines standing order
- Topical Hydrocortisone standing order
For more efficiency tips, including EHR smart phrases for HPI, procedures and patient education, as well as guidelines for SOPs, consult the College’s Employed Allergist Toolkit.
[1] These sample standing orders are for informational and educational purposes only and do not constitute medical advice, legal advice, and are not a substitute for the exercise of a user’s own independent professional judgement.
