Developing Standing Orders to Help Your Team Work to the Highest Level

 

Use this seven-step plan to create protocols that improve efficiency and reduce physician workloads.

Fam Pract Manag. 2018 May-June;25(3):13-16.

Author disclosures: no relevant financial affiliations disclosed.

Studies estimate that it would take 21.7 hours per day for a physician to provide all recommended acute, preventive, and chronic care for a panel of 2,500 patients.1 Add to this the ever-growing requirements for quality reporting, and it's no wonder physicians are burned out.

Using standing orders is one way to redistribute the physician workload across the primary care team, allowing the physician to focus on acute care and more complex medical decision making while ensuring that more routine patient needs are met by others. Simply stated, standing orders are written protocols that authorize designated members of the health care team (e.g., nurses or medical assistants) to complete certain clinical tasks without having to first obtain a physician order. Several studies have demonstrated that standing orders can increase the delivery of routine preventive care services including immunizations, leading the Centers for Disease Control and Prevention's Community Preventive Services Task Force to strongly recommend their use.2

Our practice — an urban family medicine residency with 14 faculty clinicians and 24 residents — uses standing orders not only to improve efficiency but also to contend with some additional challenges inherent in a residency practice. These include limited patient-physician continuity, care delivered by learners at varying stages of their professional growth, and a need for residents to learn the team-based approach to patient care, which is so important to being successful and effective in health care today. Of course, because standing orders allow for patient care without the direct involvement of a physician, they should be carefully designed, supervised, and revised as needed to limit the potential for errors.3 Here is the process we used to successfully develop and implement standing orders in our practice.

KEY POINTS

  • Standing orders provide written authorization for nurses, medical assistants, and other members of the health care team to complete certain clinical tasks without first obtaining a physician order.

  • Practices can use standing orders to relieve physicians of some clinical tasks so they can focus on acute care and more complex decision making.

  • Standing orders should be carefully designed and supervised and regularly revised to reduce the chances for errors.

1. GARNER SUPPORT

For standing orders to be successful, the clinic's medical director, practice manager, physicians, and staff should all support them. The medical director is responsible for approving standing orders and supervising their use, but all clinicians should agree with them to avoid confusion, mistakes, and care lapses. Focus on developing standing orders for

ABOUT THE AUTHORS

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Dr. Leubner is associate program director for clinical affairs and medical director at the Banner University Medical Center Family Medicine Residency in Phoenix. He is also a clinical assistant professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine....

Dr. Wild is the associate program director for academic affairs for the Banner University Medical Center Family Medicine Residency. She is also a clinical assistant professor in the Department of Family and Community Medicine at the University of Arizona College of Medicine.

Author disclosures: no relevant financial affiliations disclosed.

References

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1. Yarnall KS, Østbye T, Krause KM, Pollak KI, Gradison M, Michener JL. Family physicians as team leaders: “time” to share the care. Prev Chronic Dis. 2009;6(2):A59....

2. Centers for Disease Control and Prevention. Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. A report on recommendations of the Task Force on Community Preventive Services. Morb Mortal Wkly Rep. 1999;48:1–15.

3. Institute for Safe Medication Practices. Guidelines for standard order sets. http://bit.ly/2FVwEQh. January 12, 2010. Accessed March 15, 2018.

4. Immunization Action Coalition. 10 steps to implementing standing orders for immunization in your practice setting. https://bit.ly/1S5qFTe.

 
 

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