When is an order required?
Q: As a nurse, do I always require an order to implement an intervention in my practice setting?
A: Yes, nurses require an authorizing mechanism such as an order to implement prescribed interventions. Some examples of interventions requiring an order are: IV infusions, medication administration, immunizations, venipuncture, Pap test, oxygen, and catheterization. This list in not all inclusive.
There are three types of orders:
Direct Order: A prescription from an authorized prescriber to enact an intervention for a client. Direct orders are to be implemented as written unless the nurse determines a client-specific contraindication. If a contraindication is determined the nurse is accountable to contact the authorized prescriber.
Care Directive: A care directive is an order or authorization, which exists as an organizational policy. It is developed and approved by an authorized prescriber and the organization for an intervention(s) to be implemented in specific circumstances for a range of clients with identified health conditions. A care directive does not exist on each client’s individual chart, rather it is in organizational policy. The care directive must be approved by the authorized prescriber(s) of the clients in which the care directive will be enacted and by the organization. For more information on care directives visit the Care Directives Guideline.
Pre-printed Order: A list of orders for a specific health condition from which the authorized prescriber selects and signs the applicable order(s) for an individual client.
Authorized prescribers in Nova Scotia include nurse practitioners, registered nurse authorized to prescribe (RN prescriber), physicians, dentists, midwives, optometrists, pharmacists, veterinarians and dietitians in select circumstances (therapeutic diets, tube feedings, and medications that directly relate to nutrition problems). Physician assistants are not authorized prescribers, rather they are granted the authority to prescribe a defined list of medications and interventions under the supervising physician's license under NSH policy.
For further information on anything contained within this practice scenario, please contact an NSCN Practice Consultant at practice@nscn.ca.
