The document discusses standing orders, which are written orders signed by a licensed practitioner that allow nurses to provide specific care for symptoms or clinical problems without a new direct order. Examples of situations where standing orders may be used include administration of immunizations, treatment of common health issues, screening activities, and orders for lab tests. The document also provides several examples of specific standing orders related to obstetric care, postpartum care, and newborn care.

1. Mrs.Jagadeeswari.J
M.ScNursing

2. A sound understanding of the principle of
safe medication management is essential for
all nurses, midwifes and health agencies
involved in the care of patient, residents and
clients.
A standing order is a document containing
orders for the conduct of routine therapies,
monitoring guidelines, and/or diagnostic
procedure for specific client with identified
clinical problem

3. Standing Orders are
orders in which the nurse
may act to carry out
specific orders for a
patient who presents with
symptoms or needs
addressed in the standing
orders. They must be in
written form and signed
and dated by the Licensed
Independent Practitioner.

4.  Examples of situations in which standing orders
may be utilized can include,
◦ Administration of immunizations (e.g. influenza,
pneumococcal, and other vaccines)
◦ Nursing treatment of common health problems
◦ Health screening activities
◦ Occupational health services
◦ Public health clinical services
◦ Telephone triage and advice services
◦ Orders for lab tests.
◦ School health
◦ During labor.

5.  To maintain the continuity of
the treatment of the patient.
 To protect the life of the
patient.
 To create feeling of
responsibility In the members
of health team

6.  Providing treatment during emergency
 Enhance the quality and activity of health
service.
 Developing the feeling of confidence and
responsibility in nurses and other health
workers.
 Protecting the general public from troubles.
 Enhancing the faith of general public in
medical institution.

7. All IV and controlled drug must be checked by two
midwives.
 ANALGESIA- Paracetamol 1gram as a single dose,
once only
 ANTACID-Maalox suspension 10ml as a single dose
once only
or
Peptac liquid 10-20ml as a single dose
once only
 LAXATIVE- Ispaghula Husk 3.5g one sachet in water
once only

8.  IN ELECTIVE LSCS theatre. Sodium Citrate
0.3mg 30ml orally once only immediately
prior to transfer to Theatre
 I.V. THERAPY Compound Sodium Lactate 1
litre i.v. over 8-12 hours, to a maximum of
two liters
 Heparin 10IU/ml 5ml instilled into i.v.
cannula When required every 4-8 hours

9.  LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml intradermally prior to
cannulation once only or Amethocaine gel 4% 1g 45 minutes prior to
venous cannulation once only
 NIGHT SEDATION -Temazepam 10mg as a single dose up to 2.00am
in the morning.
 DINOPROSTONE VAGINAL GEL-As per induction of labor guidelines.
 FOLIC ACID -Folic acid 400microgram tablet once daily, until 12-14
weeks gestation.
 DEMULCENT COUGH-Simple linctus 5ml once only PREPARATION
 ANTISPASMODIC-Peppermint water 10ml in plenty of water, once only.

10. ANTI –D IMMUNOGLOBULIN
Anti-D immunoglobulin may be given to all
non-sensitized Rh D negative women within 72 hours
of a sensitizing event in the following circumstances
Prior to 20 weeks gestation Anti-D 250iu by I.M.
injection. The following conditions are:
 Threatened miscarriage after 12 weeks gestation
 Spontaneous miscarriage after 12 weeks gestation
 Ectopic pregnancy
 Therapeutic termination of pregnancy – medical and
surgical
 Following sensitizing events such as amniocentesis

11. After 20 weeks gestation Anti- D 500i.u. by I.M.
injection
 Ante partum hemorrhage
 External cephalic version
 Intrauterine death
 Invasive prenatal diagnostic and intrauterine
procedures
 Blunt abdominal trauma
 Routine Ante-natal Anti-D prophylaxis
Anti-D 500i.u. by I.M. injection at 28 and 34
weeks gestation

12.  ANALGESIA -Entonox inhalation as
required
 ANTI-EMETICS-Cyclizine 50mg I.M. every 8
hours as required to a maximum of
150mg/24 hours
or
Metoclopramide 10mg I.M.
every 8 hours as required to a maximum of
30mg in 24 hours or 500 micrograms per Kg
in 24 hours for women<60kg

13.  ACTIVE MANAGEMENT-Oxytocin 10 i.u.as per
unit policy OF LABOUR
or
Syntometrine 1ml I.M. with
anterior shoulder at delivery
 I.V. THERAPY -Compound Sodium Lactate 1
litre I.V. over 8-12 hours as required to a
maximum of 2 litres
Heparin 10u/ml 5ml instilled into
I.V. cannula every 4-8 hours when required

14.  LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml
intradermally prior to cannulation, once only
Amethocaine gel 4% 1g prior to
cannulation once only
 LAXATIVES-Glycerine Suppository 1 or 2 per
rectum
or
Docusate sodium 90mg micro
enema as required

15.  EPISIOTOMY-Lignocaine 1% 10ml by
perineal infiltration.
PAEDIATRICS
The following may be administered to
babies after delivery without reference
to Paediatric staff:
 Oxygen by facemask
 Phytomenadione 1mg by I.M. injection

16.  EPISIOTOMY REPAIR -
Lignocaine 1% by perineal
infiltration to a maximum of 20ml
 ANALGESIA -Only one NSAID
should be prescribed at any one
time

17.  Caesarean Section for first 24 hours:
Anaesthetist will be responsible for
analgesia. Unless contra-indicated
diclofenac suppository 100mg will be given
rectally in Theatre. One dose of an NSAID
can be given 14-16 hours after the
suppository. If Diclofenac is given, the total
dose must not exceed 150mg by all routes
in any 24 hours period.

18. Vaginal delivery or Cesarean Section after
first 24 hours:
 Ibuprofen tablet or syrup 400mg or 600mg
three times a day.
 Diclofenac tablet or suppository 50mg three
times a day (to a maximum of 150mg in 24
hours by any route).

19.  PARACETAMOL -Only one paracetamol based
analgesic should be prescribed at any one
time.
Paracetamol 1gram every 4-6 hours to a
maximum of 4grams in any 24 hours as plain
or effervescent tablets or rectally as
suppository.

20.  ANTIEMETIC- Cyclizine 50mg I.M. every 8 hours as
required to a maximum of 150mg/24 hours.
Metoclopramide 10mg I.M. every 8
hours as required to a maximum of 30mg in 24 hours
or 500 micrograms per Kg in 24 hours for
women<60kg
 LAXATIVES-Ispaghula Husk 3.5g, 1 sachet in water
twice daily
Lacunose 10ml orally twice daily
Glycerine suppository 1 or 2 per
rectum as required

21.  HAEMORRHOID-Anusol cream apply twice daily
and after each preparations bowel movement
Scheriproct ointment apply twice
daily for 5-7 days then once daily until
symptoms cleared
 I.V. THERAPY Compound Sodium Lactate 1 litre
I.V. every 8-12 hours as required to a maximum
of 2 litres
 Heparin 10u/ml 5ml instilled into I.V. cannula
every 4-8 hours when required

22.  LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml
intradermally prior to cannulation, once only
Amethocaine gel 4% 1g
prior to venous cannulation once only
 ANTI –D -Anti-D Immunoglobulin 500i.u or
more. by I.M. injection to Rh D negative women
with a Rh D positive baby within 72 hours of
delivery as per obstetric unit guidelines.
 VACCINES -Rubella vaccine (live) 0.5ml by
deep subcutaneous or intramuscular injection if
mother not immune.

23.  IRON SUPPLEMENT -Ferrous sulphate tablet
200mg three times a day if haemoglobin
below 10g/dl.
 DEMULCENT COUGH-Simple linctus 5ml 3-4
times a day preparation
 ANTISPASMODIC -Peppermint water 10ml
in plenty of water once only.