When is an order required?

This practice scenario has been developed to help nurses understand when an order is required and the three types of orders available.

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 order to implement interventions that fall outside nursing practice. Some examples of interventions requiring an order are: IV infusions, medication administration, immunizations, venipuncture, Pap test, oxygen, catheterization and digital dis-impaction. This list in not all inclusive.

There are three types of orders:

Direct Order: A prescription from an authorized prescriber to a nurse to perform 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: An order developed and approved by an authorized prescriber for an intervention or series of interventions to be implemented by another care provider for a range of clients with identified health conditions, in specific circumstances. LPNs and RNs have different roles in the implementation of care directives. RNs can determine the appropriateness of a care directive autonomously, LPNs can only determine the appropriateness of a care directive in collaboration with an RN. Both nurses can autonomously implement the care directive. For more information on care directives visit the Care Directives Guideline.

Pre-printed Order: A list of orders for a specific client for a specific health condition from which the authorized prescriber selects and signs the applicable order(s).

Authorized prescribers in Nova Scotia include nurse practitioners, physicians, dentists, midwifes, optometrists, pharmacists and veterinarians.’

For further information on anything contained within this practice scenario, please contact an NSCN Practice Consultant at practice@nscn.ca

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