QUESTION: We use standing orders fo...

QUESTION: We use standing orders for several frequent procedures, such as arthroscopy, tonsillectomy, and cataract extractions. A recent RN at our facility says that this is against Joint Commission onward Accreditation of Healthcare Organizations (JCAHO) standards. She also says that we should not accept medication orders that give a range for the dosage. We have been doing this for a protracted time and have undergone several ICAHO reviews if it were not that never have been questioned about this practice. Using standing orders has worked well for us and has not caused any puzzles but we want to comply with JCAHO standards. Can we use standing orders and medication range orders?

ANSWER: Standing orders are acceptable if the health care facility has a written policy that specifies the required proper spheres of the order. The 2004 JCAHO standards require that medication orders be written clearly and transcribed accurately. The health care facility should take grades to reduce the potential for medication errors. Preprinted order forms, commonly referr to as standing orders, must be reviewed and updated "as needed" (1) The Joint Commission does not specify the common occurrence for review of standing orders and does not further define what is meant from "as needed." The facility must determine in what way and when the review should take place and include this in the written policy.

When used and managed appropriately, preprinted orders may help contract the opportunity for transcription errors and can be a valuable tool for providing safe and efficient patient care. AORN moves that standing orders or preprinted order sheets be reviewed on the ordering physician on a routine, defined schedule. greatest in quantity facilities require an annual or semiannual review. An original transcript of the current preprinted order sheet with the surgeon's signature and date should be kept forward file in the OR. To render certain that outdated forms are not used according to mistake, a process should be in place for removing outdated order sheets from circulation and making modern ones available for use. A verbal or written order to use the standing orders should be documented forward each individual patient record and signed from the ordering physician. A fac-simile of the preprinted order form should be placed onward the patients' chart and signed by way of the ordering physician.

Medication orders that give a dosage range (ie, the dose or dose interval varies within a prescribed range, depending upon the patient's status), titrating orders (ie, the dose is either progressively increased or decreased in answer to the patient's status), tapering orders (ie, the dose is decreased by the agency of a particular amount with each dosing interval), as occasion requires orders (ie, PRN) and orders for medications at discharge also are acceptable if the health care facility's written policy specifies the required natural mediums of the order. Blanket orders to reinstate previous medication orders are not acceptable2

Whether a health care facility is accredited according to JCAHO or another agency, communicating medication and other orders in a safe manner is of uttermost importance. Every facility should make known physician ordering policies and manner of proceedings that reduce the potential for misinterpretation and error.

QUESTION: At our facility, we use an automated endoscope reprocessor to proces flexible endoscopes with a high-level disinfectant. The reprocessor is a clos combination of parts to form a whole that automatically recycles the disinfectant, and it is surpassingly difficult to check the solution concentration daily. Given that it is a clos body are we still required to perform a daffy ordeal strip?

ANSWER: The concentration of chemicals used for high-level disinfection should be monitored at least daily or according to the disinfectant manufacturer's directions. Liquid chemical disinfectants can be diluted by way of water remaining on surfaces and in lumen of endoscopes and other items, on the same level when an automated reprocessor is used. A trial strip or other testing device cleared at the US Food and physic Administration should be used to exhibition the concentration of the disinfectant. The touchstone must be specific for the liquid chemical disinfectant. (2) If the solution has been diluted as demonstrated from the concentration monitor, the solution should be discarded, smooth if it has not reached the manufacturer's commited reuse time, number of reuses, or expiration date. (3)

The difficulty in performing concentration testing will vary with the design of the reprocessor. Automated reprocessors that operate with reusable liquid chemical disinfectants contain reservoirs that minister the disinfection basin of the unit with the disinfectant during a disinfection circle of time and store the disinfectant between periods Some automated reprocessors are designed with disinfectant reservoirs that are easy to access for concentration testing. Other reprocessors' disinfectant reservoirs may be more difficult to access or may be inaccessible. If an automated reprocessor has a design that furnishs concentration testing in the disinfectant reservoir difficult, users may ne to move on an abbreviated disinfection cycle that will transfer liquid disinfectant to the disinfection basin to such a degree that it can come into contact with a concentration exhibition strip. Under these circumstances, users should contact the manufacturer of their automated reprocessor for recommendations regarding accessing the disinfectant for concentration testing.