Standing Orders
Policy
Standing orders give a specific person who does not have prescribing rights (usually a registered nurse) the authorisation to administer or supply medicines specified in the standing order.
Standing orders processes must be followed closely and comply with:
When using a standing order the medicines must be administered 
within the primary healthcare setting.
Use of standing orders is included in the induction and orientation of clinical staff.
Failing to meet the requirements of the Medicines (Standing Order) Regulations 2002 is an offence and the Ministry of Health can audit standing orders at any time to check the correct process is being followed. Source RNZCGP Indicator 9.2
Issuing a standing order
Standing orders must have only one issuer – either a general practitioner or nurse practitioner. The issuer's name must be clearly stated on the document.
The issuer has the same accountability as they do when personally generating a prescription, or administering a medicine. They are ultimately accountable for the administration, and supply or use of that medicine.
The named issuer is responsible for ensuring that the legislative requirements of the standing order are met:
- anyone working under the standing order is sufficiently trained and competent
- each standing order is audited or countersigned as needed
- each standing order is reviewed within the required timeframe and at least annually.
If any details on the standing order change, or the issuer has left the organisation, a new standing order must be created.
All details about each standing order are included in a signed individual standing order document. This includes who is authorised to use it, the procedure to follow, and whether the standing order will be audited or countersigned.
Standing orders must:
- specify the period for which they apply
- be reviewed by the issuer at least annually, or sooner if something changes.
A standing order template is available in the resources section of RNZCGP Indicator 9.2, Standing orders
Staff who can work under a standing order
Staff who can work under a standing order are usually regulated health practitioners. Any risks associated with Non-regulated staff working under SO should be carefully considered and measures taken to reduce or prevent those risks.
See RNZCGP guidance, within Indicator 9.2, Standing orders, on the risks of authorising non-regulated healthcare workers to administer and/or supply medicines under a standing order.
All staff working under a standing order are trained and assessed as competent by the issuer, before the issuer authorises them to use that standing order. Staff administering high-risk medicines under standing order are given additional training as needed. The competency of each person working under each standing order is reviewed at least annually.
Staff training is completed online or in-house.
Using a standing order
Staff who supply medication under standing order accept accountability for their clinical practice. This includes:
- assessing the patient to determine whether use of the standing order is indicated
- being competent to administer the medicine
- assessing any contraindications or exclusions
- identifying ongoing monitoring and/or follow up.
For all medication issued under a standing order, the staff member records details of the consultation and medication/s supplied in the patient record.
Our standing order documents are kept in the practice manager's office.
If a staff member's competency using a standing order comes into question, the issuer is responsible for raising it with them and developing an appropriate corrective strategy. The staff member's authorisation to use the standing order may be cancelled until they regain competency. Once competency is regained, all steps must be documented, and a new SO created.
If there is an adverse event or near miss from medicine administered under standing order, manage and report it according to the practice's Adverse Events policy.
Vaccines
A standing order may be used by staff administering vaccines who are not authorised to do so, or whose authorisation is pending.
Countersigning and auditing
The countersign or audit requirement is decided by the issuer and is detailed in the individual standing order document.
We use tasks and codes in the PMS to identify when standing orders have been used so they can be approved, countersigned, and/or audited by the issuer.
Any issues identified during countersigning or the audit process should be addressed promptly.
Countersigning
Some standing orders may require countersigning.
The need for countersigning, and the timeframe within which it must be done, are determined by the issuer.
Auditing
Standing orders that do not need countersigning (or need countersigning less than once a month) must be audited.
At least once a month, the issuer checks a sample of each administration or supply given under the standing order. Record the audit results, as well as any changes or improvements needed.
Full countersigning and audit requirements are detailed in the Ministry of Health's Standing Order Guidelines, (Section 10)
Annual review
The issuer reviews each standing order annually, or if something changes. The annual review can't be delegated and must be carried out by the named issuer.
In an annual review:
- determine whether standing order is still needed
- update the document if necessary
- re-sign and re-date standing order.
If information in a standing order is updated following review, the issuer communicates this to the authorised nurses and arranges additional training if needed. Obsolete standing orders should be replaced with the new versions so that out-of-date versions cannot be used in error.
Supporting documentation
Details related to the authorisation requirements of each standing order are documented in our authorisation register. The information in the register should align with the individual standing order.
All documentation that supports standing orders is managed by the lead nurse. However, the issuer is responsible for document control directly related to the standing order document.
Related policies
Standing orders documentation for the practice