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Standing Orders These standing orders are approved by the medical director and providers of Community Health Care, Inc. Appropriate staff Medical Assistants (MA’s), and/or, Licensed Practical Nurses (LPN’s) and/or Registered Nurses (RN’s) who have been appropriately trained with documented competencies may initiate these orders.Urine AnalysisAppropriate Staff: MA’s, LPN’s and RN’sApplicable Departments: Family Practice, Pediatrics and Obstetrics Order: Pregnant women Appropriate staff is authorized to obtain a routine UA on all pregnant women Order: All patientsAppropriate staff is authorized to obtain a UA on patients with the following: Patient presents with one or more of following symptoms:Pain or burning with urinationFrequent or urgent need to urinateCloudy urineBlood in the urineFoul or strong urine odorNeed to urinate at nightPatient may also complain of:Pressure in lower pelvisFeverChillsLower back or flank painDocumentation: Appropriate staff will indicate on the encounter the UA was performedRapid Strep TestAppropriate Staff: MA’s , LPN’s and RN’sApplicable Departments: Family Practice, Pediatrics and ObstetricsOrder: Appropriate staff is authorized to obtain a rapid strep test on patients with the following: Patient presents with two or more of the following:Sore throatTonsils that appear red with white or yellow spots at the back of the throatFever of 101 F(38.3 C) or higherPain and difficulty swallowingSwollen lymph nodes in neckOther symptoms:HeadacheWeaknessLoss of appetiteDocumentation: Appropriate staff will indicate on the encounter the rapid strep was performedHbA1c Appropriate Staff: MA’s, LPN’s and RN’sApplicable Departments: Family Practice and ObstetricsOrder: Appropriate staff is authorized to perform a finger stick HbA1c on a patient with diabetes who’s most recent HbA1c is more than 90 days old.Documentation: Appropriate staff will document HbA1c on the encounterGlucose Appropriate Staff: MA’s, LPN’s, RN’sApplicable Departments: Family Practice, Pediatrics and ObstetricsOrder: RN’s will perform finger stick Glucose on patients’ with symptoms of hyperglycemia or hypoglycemia. MA’s, LPN’s, RN’s are authorized to perform a finger stick Glucose on any patient with diabetes.Documentation: Appropriate staff will document glucose testing performed on encounterLead Screening Appropriate Staff: MA’s , LPN’s and RN’sApplicable Departments: Pediatrics Order: Appropriate staff is authorized to obtain a lead screening on patients without a documented lead screening at 12, 18 and 24 months and again at 3, 4 and 5 years. Documentation: Appropriate staff will document lead screening ordered on the encounter and send the patient to the lab.Reflexed Urine Culture and SensitivityAppropriate Staff: Laboratory StaffApplicable Departments: AllOrder: Reflex urine culture will be done when one or more urinalysis results are present. Dipstick result: Nitrite: PositiveLeukocyte Esterase: Moderate or LargeMicroscopic Exam:WBC’s: 5 to 10 or greaterBacteria: Moderate or ManyEmergency Medication AdministrationAppropriate Staff: RN’sApplicable Departments: Family PracticeOrder: Emergency medications may be administered when a patient presents with intense pain or uncomfortable pressure in the middle of his/her chest; lasting longer than 1 minute and is accompanied with one or more of the following symptoms:Squeezing chest pain (substernal/left side)Sweating and nauseaSevere shortness of breathMedication to be administered in the following order:Oxygen per nasal cannula 2 to 4 liters as neededAdminister Nitro 0.4mg sublingual; 1 every 5 minutes for unrelieved chest pain (total doses 3) only if systolic blood pressure is > 100 mm HgNurse/provider will evaluate if additional outside emergency assistance is needed.ASA 81 mg 4 chewable tabsPrior to administration nurse will identify any allergies or contraindicationsDocumentation: Appropriate staff will document outcome of emergency situation in the patients chart. These standing orders are reviewed and revised annually if necessary. I authorize appropriate staff to perform the above standing orders.Medical Director Signature: ______________________________Date: _____________ ................
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