NZ School Nurses

An Introduction to Standing Orders

We've had a number of questions around Standing Orders in schools.... what are they, how they work and how you use them. So we thought we'd compile these in a blog post for those who may also have the same questions! Here goes.... 

 

What is a Standing Order? 

(In the School Based Health setting), A Standing Order is a written instruction issued by a GP or NP. It authorises a nurse who does not have prescribing rights to administer and/or supply specified medicines. The intention is for Standing Orders to be used to improve patients’ timely access to medicines; for example, a registered nurse in a school with no school GP/NP available. Have a read through the legislation to become more familiar with it - MOH Standing Order Guidelines and the NZNO Guidelines on standing orders

 

Who writes the Standing Order? 

The Issuer. The issuer is usually the GP or NP. Occasionally, these can be written by a group of doctors if they are collectively employed. 

 

Who signs the standing order? 

Both the issuer and the nurse administering the Standing Order need to sign and date the Standing Order in order for it to be valid. Your Principal does not sign the Standing Order. 

 

If I sign a standing order, do I have to give that medication?

No, if you are not confident or do not feel the medication is warranted, you do not have to give the medication. We would recommend that you discuss any concerns you have with the GP or NP, and document your rationale in the patient notes. 

 

The GP at my school has a different employer to me. Does that affect whether we can both sign a Standing Order for use at my school? 

The Issuer and person administering the Standing Order do not have to be part of the same company to issue a standing order. The MOH guidelines as per NZ legislation do not limit them to being within the same company. 

 

I don't have a GP at my school. Could Standing Orders apply to me? 

Many School Nurses get their local GPs to supply Standing Orders. This is best done by approaching local practices (with the support of the senior management team at your school) and discussing your needs with them. Consider what would initially be most helpful to have a Standing Order for. Not all GP's will be comfortable signing a Standing Order if they haven't worked with you before, and they can choose not to sign a Standing Order if they wish. We would encourage you to build up a relationship with your local practice and be willing to provide them with the information they need to see that Standing Orders would benefit the Young People you see.  

 

Where do I get a Standing Order from? My GP said they don't have time to write it from scratch. 

The MOH Standing Order Guidelines have an appendix attached at the end of the document which can be used as a guide for writing a Standing Order. We have written a number of specific Standing Order Templates commonly used in schools which may save you more time. You can access and download these for use from our 'Resources for Nurses' page. 

 

What else do I need to know in order to use Standing Orders correctly? 

We would recommend that you read through the MOH Standing Order Guidelines Checklist (pg 14) to ensure your Standing Order meets all the essential criteria, and that you are familiar with the legislation around Standing Orders. It is the responsibility of the Issuer and person administering the Standing Order to meet all the requirements. Each Standing Order is valid for a maximum of a year, and a new one must be re-signed after this time period. 

 

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We hope this is useful- we've left the comments section open on this blog post, so if you have further questions about Standing Orders, please feel free to write us a comment/question. 

Comments

Bethan

Bethan

Shirley, just to clarify, are you working in New Zealand as your reply came up as from USA? This information is all for New Zealand schools as there may be different rules in different countries.

29 November 20186:48

Shirley

Shirley

I am in a private school setting. We have a contract with a physician who has given standing orders. His orders specify that a student can receive an OTC med no more than twice a year for each symptom. The parents, at the beginning of the school year, give permission for their child to have OTC medications. We also have a medication authorization form for parents to fill out and have signed by their physician for OTC medications as well as prescribed. My question is - if a student needs an Advil for the third time and his parents have not had their physician sign the medication authorization form (even though they’ve implicated “yes” to OTC on the electronic record), can that student only be allowed an OTC med due the existing standing order. I appreciate any help/insight anyone can offer, thank you!!

29 November 20185:58

Shirley

Shirley

I am in a private school setting. We have a contract with a physician who has given standing orders. His orders specify that a student can receive an OTC med no more than twice a year for each symptom. The parents, at the beginning of the school year, give permission for their child to have OTC medications. We also have a medication authorization form for parents to fill out and have signed by their physician for OTC medications as well as prescribed. My question is - if a student needs an Advil for the third time and his parents have not had their physician sign the medication authorization form (even though they’ve implicated “yes” to OTC on the electronic record), can that student only be allowed an OTC med due the existing standing order. I appreciate any help/insight anyone can offer, thank you!!

29 November 20185:01

Linda

Linda

They are not RNs so they are not covered by our standing orders I am thinking. Thanks.

3 July 201811:31

Bethan

Bethan

Yes they can be. Standing orders are applicable in any setting and the templates available can be modified as needed. The issuer usually needs to be GP or nurse practitioner and if the matron is an RN they can administer it.

3 July 20188:26

Linda

Linda

Do these standing orders cover matrons in a boarding school?

3 July 20187:44

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