A standing order in medical practice is a pre-approved, written protocol that allows licensed healthcare personnel to perform specific, standardized actions for a patient who meets defined criteria without requiring a physician’s individual authorization at the time of service. This structured approach is designed to streamline patient care for routine, common, and evidence-based procedures, improving efficiency and patient access. The primary goal is to ensure timely care and allow physicians to focus their attention on more complex or acute medical issues.
Defining the Standing Order
A standing order is a formal medical treatment order that outlines a specific procedure or treatment plan, conditioned upon the occurrence of certain clinical events. The order dictates the exact circumstances, patient criteria, and precise steps that must be followed for the action to be taken. This mechanism allows qualified non-prescribing staff, such as nurses, pharmacists, or medical assistants, to initiate care.
For example, a standing order for a vaccine would specify the patient’s age range, any contraindications, the exact dosage, and the administration route. This differs significantly from a traditional, patient-specific prescription, which is written by a provider for one individual after a direct consultation. If a patient’s symptoms or circumstances fall outside the clearly defined parameters, the staff member must consult with a physician for a patient-specific order. The use of standing orders promotes consistent, high-quality treatment across a facility.
The Authorization and Review Process
A standing order requires formal authorization from high-level clinical leadership and is not developed or implemented by the personnel who carry it out. Before implementation, the protocol must be reviewed and signed by an authorized, licensed practitioner, typically a physician (MD or DO) or a medical director. The development process involves a multi-disciplinary team, including medical staff, nursing, and pharmacy representatives.
Staff members who will execute the standing order must receive documented training on the protocol’s requirements, limitations, and documentation procedures. To maintain safety and relevance, standing orders must undergo a periodic review, often annually, to confirm they remain consistent with the latest standards of practice. Documentation is a major requirement, as the use of the standing order must be recorded in the patient’s medical record as a formal order, including the date and time of its initiation. The review process also assesses whether any preventable adverse events resulted from the protocol’s use, allowing for necessary revisions to be made.
Common Uses in Healthcare Settings
Standing orders are most effective in clinical environments that offer repetitive, standardized services to a large number of patients. They are commonly applied for routine immunizations, such as influenza, COVID-19, or pneumococcal vaccines, in settings like pharmacies, public health clinics, and primary care offices.
They are also widely used for various screening tests and laboratory procedures. For instance, a standing order may permit a medical assistant to perform a strep throat or influenza swab test on a patient presenting with defined symptoms before a physician sees them. Similarly, they can authorize certain blood draws, like those for blood sugar checks or routine lab panels, to be completed as part of an established procedure.
In public health and community settings, standing orders have proved valuable for improving access to medications. Many states use them to allow pharmacists to dispense the opioid overdose reversal drug naloxone or to provide hormonal contraceptives without an individual prescription. In hospital settings, standing orders are often used for administering specific over-the-counter pain relievers or for initiating standardized care bundles for conditions like chest pain or sepsis.