P&P Standing vs. Stop Orders

Standing vs. Stop Orders

Standing orders empower nurses to pass over-the-counter medications at their discretion for a given period of time. Stop orders are the automatic expiration of these orders.

Let’s examine the procedures for both more closely.

STOP ORDERS

Unless an order specifies otherwise, orders for a new medication automatically stop after a predetermined period of time. This is referred to as a stop order.

Whether for routine or as needed (PRN) use, the following classes of meds are stopped automatically after 10 days:

• Anti-infectives for acute conditions

• Ophthalmic antibiotic and steroid preparations for acute problems

• Cough and cold preparations

• Decongestants and antihistamines for acute conditions

• Controlled substance analgesics for acute conditions

All other medications are stopped automatically after 60-90 days unless reordered. This includes all PRN orders except nitroglycerin, antihypertensives, anticonvulsants and medication ordered for chest pain (such as morphine, betablockers and those listed above).

Notify the prescriber before administering the last dose to allow them the option to continue the medication without interruption.

Unused Medications

If a medication is not used at all within 30 days of receipt, it may be discontinued unless the prescriber specifically orders otherwise. In this case, your staff must:

1. Notify the prescriber of the discontinuation;

2. Enter the discontinue (D/C) order on the physician orders sheet and note it on the medication record;

3. Remove any remaining medication from the resident’s supply and dispose of it appropriately to avoid a medication administration error.

Key Points to Remember

• When a prescriber gives the order for a medication covered by the stop order policy, a licensed nurse must request a specific duration of therapy for that order. This duration supersedes the stop order policy.

• Certain medications should not be discontinued before consulting with the prescriber and determining a taper schedule.

• Always record the stop date in the appropriate area of the medication record whenever you enter medications covered by the stop order policy.

• Keep a current copy of the policy in the front of every medication administration book and provide a copy to all prescribers with a cover letter explaining the policy.

STANDING ORDERS

A standing order allows nurses to administer medications as needed. Before a standing order is ever implemented, documentation of the reason for the order must be written following the procedure for verbal prescriber orders and placed in the resident’s medical record.

• Mark the order “s.o.” to clearly indicate that it is a standing order.

• Only a licensed nurse can implement such orders.

• Standing orders cannot be renewed. Contact the physician if the condition persists after the stop order deadline (or sooner if you judge necessary).

• The corresponding automatic stop order listed for each condition and treatment is used when initiating a standing order.

Your community’s policy on standing orders must be sent to all physicians with a cover letter explaining the policy and placed in all of your residents’ medication records. For every resident with a standing order, maintain an authorization signed by their physician in their medication record.