All providers - nurses, MAs and other staff members - are responsible for the care they provide, which includes carrying out standing orders. These orders should be formulated and approved by committees or group reviewers with respect to available resources and these guidelines and recommendations. Carefully formulating standing orders with supervision will reduce the risk of errors. Standing orders should be reviewed and revised at minimum annually. Neither state nor federal law are required to allow institutions the ability to implement standing orders, thus the scope of practice should be considered when writing the standing order. The Centers for Medicare & Medicaid Services (CMS) requires that standing orders be based on evidence-based guidelines and recommendations. They also identify the related specific patient population served and designate the level of supervision and the locations of which the patient population may be served. Therefore, standing orders delineate the specific type of medical practice and the protocols the nurse must follow. 5Įxamples of standing orders include immunization administration, health screening activities, preventive care measures, ordering lab tests or treatments for certain categories, diabetes measures, prescription refills, and pre-/post-operative orders. Patient-specific standing orders allow patients to be serviced in a more efficient and timely manner regardless of the provider’s location. Condition-specific standing orders are not dependent on the relationship between provider and patient but to the protocols of care directives for specific conditions and diseases. Standing orders may be specific to patients or conditions/diseases following healthcare needs. 4 The staff are able to submit orders based on the protocol without the physician or clinician examining the patient. The authorized provider defines the circumstances and parameters in which a nurse, medical assistant (MA) or other medical support staff can place a medical order. Standing orders are care directive protocols approved by an authorized provider such as a physician, dentist, physician assistant (PA) or nurse practitioner (NP). Implementing standing orders have shown to increase efficiency, patient satisfaction and care, as well as patient quality care, which helps healthcare provider organizations address the Quadruple Aim and reduce physician burnout. 3 Some solutions to physician burnout include appropriate distribution of job roles, optimizing the EHR, reducing redundant data entry and using support staff to offload clerical burdens. 2 Work factors are noted to contribute to high levels of physician burnout, including inefficient work processes and computerized provider order entry (CPOE). The prevalence of physician burnout has been reported near or exceeding 50% in physicians-in-training as well as practicing physicians in the United States. While the transition to value is a widely accepted concept to optimize provider performance nationwide, clinicians report increasing levels of burnout and stress related to the increasing levels of administrative burden. With this goal in mind, the Quadruple Aim framework outlines four important components: improving population health, reducing cost of care, enhancing patient experience and improving provider satisfaction. By Lauren Robinson, DO, family medicine resident, Augusta University, Medical College of Georgia, Augusta, Ga., Juliana Van Alstine, certified nursing assistant, James Mayers, MD, family medicine resident, Augusta University, Medical College of Georgia, Augusta, Ga., Carla Duffie, DNP, MHSA, PCMH-CCE, NEBC, nurse manager, family medicine clinic, Augusta University, Medical College of Georgia, and Janis Coffin, DO, FAAFP, FACMPE, MGMA member, chief transformation officer, Augusta University Health, Augusta, Ga., healthcare industry is in the process of transitioning from a fee-for-service (FFS) model to a value-based care model to improve healthcare outcomes and lower overall medical costs.
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