Unsolicited POC Orders in the oupatient/ambulatory setting

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In our health system we mainly use solicited work flows ( interfaced orders that require an order ahead of time) and more rarely use unsolicited workflows (interfaced orders that do not require and order ahead of time and automatically post to the EMR). Within our hospitals we utilize an unsolicited workflow with our glucometers, in order to satisfy the need for a provider order we utilize nursing communication orders that get signed off by the provider. This works out well in the hospital but not so well for outpatient.

My question centers are unsolicited workflows specifically in the outpatient setting: Does anyone utilize this workflow in their outpatient settings? How do you satisfy the need for a provider order?

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Nurses should never act alone and should be based on provider's orders.

We had a Joint Commission surveyor bring this topic up. She said that we should have an order unless it is part of a documented protocol.

I think the documented protocol might be key to you. Please see the Joint Commission standards below; I'm not sure what agency you are affiliated with.

Hope this helps

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Along the lines of Jo Win's post, we use 'delegated standing orders' which are reviewed and approved, signed, by the clinical-side medical director and chief nursing officer. We are surveyed by Joint Commission so what's in the yellow box applies to our SDO process in ambulatory.

All inpatient POC testing is unsolicited.  We only use solicited testing for outpatients.  We use Cerner, so any POC order will be put in as a communication order for the specific department that is required to collect the sample.

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Kyle Jollotta
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