Practice Alerts and GuidelinesNon-Patient Specific Standing Order and Protocol GuidelinesGeneral Information | RN Obligations | Information for Pharmacists | Prescriber Obligations | Frequently Asked Questions Show
General InformationThe law and regulations on the administration of non patient specific orders for certain immunizations, anti-anaphylactic agents and PPD mantoux skin tests standardize practice across all service delivery systems. Implementation of this law has the effect of freeing up some agencies from the need for patient specific orders, while other agencies will need to incorporate new and safer practices in order to be in compliance with the new law and regulations. Non-Patient Specific OrdersA non-patient specific order authorizes named RNs or RNs who are not individually named but employed or under contract with a legally authorized entity, to administer specified immunization agents or anaphylaxis treatment agents for a specified period of time to an entire group of persons such as school children, employees, patients of a nursing home, etc. Some health care agencies think non-patient specific orders refers only to giving immunizations to employees. Such orders can actually be much broader than this. Some examples of non-patient specific orders are:
Immunizing AgentsMany of the immunizations listed in the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) guidelines may now be legally administered in New York State, under non-patient specific orders following specific protocols. The list of authorized immunizing agents differs for adults and children. Adults are persons who are 18 years of age or older; children are persons under 18 years of age. The agents are:
* The Board of Regents may add immunizing agents in accordance with the recommendations of the Centers for Disease Control and Prevention and the New York State Department of Health. Any additions will be posted on this site immediately. Administration of Immunizations
EpidemicsAny RN may administer any immunizing agent that is authorized by a non-patient specific standing order and protocol as part of an immunization program authorized, maintained or under the auspices of the State Commissioner of Health, a county commissioner of health, or a county public health director when the immunization program is instituted as a result of an epidemic declared by any of these public health officials. Registered Professional Nurse ObligationsCPRAll RNs involved in the administration of immunizing agents in accordance with a non-patient specific standing order and protocol must be currently certified in CPR by the American Red Cross, American Heart Association or an equivalent organization acceptable to the State Education Department. Staff development or inservice departments that train individuals in CPR but do not necessarily provide "certification" are considered equivalent organizations by the Department. Protocol Requirements
Anaphylaxis Administration Requirements
Anaphylaxis Protocol
Purified Protein Derivative (P PD) Mantoux Tuberculin Skin Test Administration Requirements
PPD Protocol
Professional MisconductProfessional misconduct in the practice of nursing and in the administration of immunizations and/or anaphylactic treatment agents following non-patient specific standing orders and protocols will include but is not limited to:
Information For PharmacistsSyringes and needles needed for administration may be provided to RNs. The sale of these immunization agents and needles and syringes may be considered a wholesale transaction. A wholesale registration from the State Board for Pharmacy will not be necessary for either of these transactions. Prescriber ObligationsThe non-patient specific standing order and protocol must be authorized by a physician or a certified nurse practitioner. Non-patient specific standing orders for immunizations must contain the following: EITHER
Frequently Asked QuestionsImmunizing Agents | Requirements | Recordkeeping and Reporting | Development of Regulations | Further Information Immunizing Agents
Requirements
Recordkeeping & Reporting
Development of Regulations
Further Information
Which nursing action should ensure that a medication is given to the right patient?Right Patient
The nurse must confirm the patient's identification matches the medication administration record (MAR) and medication label prior to administration to ensure that the medication is being given to the correct patient.
Which nursing action are most appropriate for medication administration to a client at risk for aspiration?Position the patient in a side-lying or upright position to decrease the risk of aspiration. Offer a glass of water or other oral fluid (that is not contraindicated with the medication) to ease swallowing and improve absorption and dissolution of the medication, taking any fluid restrictions into account.
Is it safe to crush an entericDo not crush or chew enteric-coated tablets. Doing so can increase stomach upset. Do not crush or chew extended-release tablets or capsules. Doing so can release all of the drug at once, increasing the risk of side effects.
When will the ideal time for the nurse to schedule a trough level?When a trough is drawn, the provider is examining what the concentration of a certain medication is at its lowest therapeutic level. This is typically done 30 minutes before the next dose is scheduled to be administered.
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