Standing Orders Policy

Policy ID: SO

Version 1.0

Date: 09/02/2017

Last review 17/06/2025

Purpose:

• To ensure the safe use of Standing Orders within our practice
• To enable the timely access to medications for our patients.
• To help ensure that all members of the team are working at an appropriate and consistent level of competence and confidence within their scope and level of experience.

Responsible Staff:

Implementation: Clinical Director

Action: Clinical Staff, Quality Administrator

Audit: Clinical Director

Audit:

Training Resources:

There is a suite of centrally maintained training resources available for staff on healthpathways (search standing orders)

Linked Policies:

Individual Standing Orders may be considered to be linked to this policy.

The Standing Orders that we use

• Uncomplicated Lower UTI in Women
• Vulvovaginal Candidiasis (Thrush)-Clotrimazole cream
• Emergency Contraceptive - Levonorgestrel
• Chlamydia treatment
• Contraception - Medroxyprogesterone Acetate (Depo-Provera)
• Pink Lady administation
• Salbutamol for Spirometry Reversibility Testing
• Acute Chest Pain - Glyceryl Trinitrate
• Acute Chest Pain - Asprin
• Oxygen
• Paracetamol for Bexsero Administation
• Traumatic Wounds- Tetanus Vaccine (Tdap)
• Emla 5% topical anaesthetic cream
• Skin Laceration-Lidocaine 1 to 2%

Policy:

A Standing Order gives appropriately trained registered nursing staff who may not be able to prescribe independently to administer or supply medication under appropriate, carefully defined conditions. 

Each medication to be administered or dispensed must have its own Standing Order defining the conditions under which it may be used, and each Standing Order must have appropriate training resources to ensure safe use.

The Standing Order Register, which is kept by the Lead Practice Nurse, records which staff have completed the necessary training and are permitted to use Standing Orders.

Our practice has agreed to use the electronic Standing Order framework developed by the Canterbury and West Coast Standing Order Development Group.

In order for a nurse to issue medication under a Standing Order, all four of the following conditions must be met.

1. The Registered Nurse must have completed the appropriate Health Learn pathway.
2. A Vocationally Registered medical practitioner must agree that they are competent.
3. The Standing Order register must be signed by the assessing Vocationally Registered medical practitioner.
4. A copy of the Standing Order Register is placed in the personnel file of the Registered Nurse

A nurse practitioner can authorise and audit standing orders per the individual standing order policy.

When Standing Orders May be Used:

• When an authorised RN is caring for a patient after hours and needs to supply pre-packaged and labelled medications to the patient;

• When an authorised RN is caring for a patient during office hours, the patient needs medications and a registered clinical practitioner is not readily available to write a prescription. Pre-packaged and labelled medications are therefore provided to the patient.

How Standing Orders Are to be Used:

A thorough medical consultation is required prior to the issuing of medication under any Standing Order.  The usual standard of professional record keeping shall apply, including but not limited to:

• details of the history of the presenting problem described by the patient;

• the assessment carried out including examination and investigations;

• the working diagnosis;

• the medication provided (including dose, route of administration and quantity);

• any other treatment provided;

• arrangements made for ongoing monitoring and follow up, (which may include scheduling a follow up appointment with a GP);

• that the treatment was provided under SO and countersigning has been requested.

For registered patients, the following information is usually included as part of the clinical record, but must be checked.  Casual patients also require the recording of:

• past medical history;

• allergies; 
  

• current medications;

The recording of allergies for casual patients carries risk - DO NOT use 'no known allergies' in the medical warnings section as we do not curate their list of allergies and this may lead to confusion when considering record sharing.  Instead, record known allergies in the 'medical warnings' system but record the lack of allergies only in the clinical record.

If after making an appropriate assessment, the Registered Nurse feels that the conditions for the use of a particular Standing Order have been met, AND they are appropriately signed off, AND that in this particular case the use of the Standing Order is appropriate, then the Registered Nurse may dispense the medication specified in the Standing Order to the patient.

Medication suitable for such supply must be in individual course-size bottles pre-prepared from the pharmacy.

Each Standing Order Use must be notified to a Medical Practitioner on use for sign-off- This can be done by sending a task to the next available doctor (to create a record of the request) AND adding the patient's name to the end of the doctor's list (to ensure the sign off is prompt) with the note 'for SO sign off please' - the doctor shall check that the use of the Standing Order was appropriate and so annotate in the record, or otherwise take appropriate remedial action without delay.  The use of the wording: "Use of standing order checked and approved" is recommended for sign-off.

In order to facilitate identification of which consultations have involved use of a standing order, the registered nurse shall enter a screening entity of SO, specifying which standing order has been used.

If there are concerns about the appropriate use of a Standing Order, then a task should be sent to the Clinical Director with details of the cause for concern.

Note on Liability

The registered medical practitioner providing ongoing care of the patient is ultimately responsible for the Standing Order.

Nursing Staff are accountable for their decision-making during the use of Standing Orders.

Standing Orders are updated annually and nursing staff need to be aware of any changes in Standing Orders.  These are not 'once and done' learning processes.

The standard of labelling, storage and other medication–related advice given with medicines supplied under a Standing Order should meet the expected level provided should the medicine otherwise have been dispensed at a pharmacy.

Standing Orders shall apply only when a registered medical practitioner is not available to provide a prescription for medication.  This may include times when a registered medical practitioner is in the building but is otherwise engaged in clinical duties.

Where the patient is to remove medication from the practice, the medication may only be dispensed in the pre-labelled packages provided.

Training and Competence to use Standing Orders:

Registered nurses who dispense medication under a Standing Order must understand that they are responsible for assessing the patient and ensuring that the medication is only dispensed in accordance with the provisions of the Standing Order.

Each Standing Order will describe the level of training and competence expected, including how this is to be assessed.  This includes but may not be limited to Healthlearn on Healthpathways.

Before any medication may be issued under a Standing Order, the Registered Nurse must ensure that the Clinical Director has signed the appropriate Competence Register for that particular nurse and that particular Standing Order.

The Quality Administrator shall be responsible for ensuring that the Competence Register is maintained appropriately.

Adverse Events:

If an adverse event occurs, this shall be handled in accordance with our Significant Incident Policy.  In addition, the registered nurse involved MUST NOT issue further medication under standing order until the Clinical Director has given approval.

We recognise that most adverse events will not be the result of any staff failing, but patient safety is our priority.

Change Log:

17/6/25-

Update Policy to reactivate policy.

Add Standing Orders currently in use.

Change: Nurse practitioners may not authorise standing orders, to, a nurse practitioner can authorise and audit standing orders per the individual standing order policy.

Some format and syntax modifications.

09/11/2021 -

major re-write not effectively changing the meaning of any section however placing policy in abeyance pending certainty of training.

added clearer definition of what a Standing Order is.