1. Brooke, Penny Simpson RN, MS, JD

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I'm an OR nurse who just started my first job. One of the surgeons faxes us preprinted orders for all his patients, including orders for the same couple of antibiotics. We're supposed to choose the antibiotic from the order form depending on patient allergies and administer the standard dosage. Are standing orders that use a "one-size-fits-all" approach okay legally?-J.B., N.Y.


Standing medication orders that leave the decision making to people with no prescriptive authority are dangerous and illegal, and you shouldn't go along with such a substandard protocol. You could be charged with prescribing or dispensing medication, which are both beyond your scope of practice unless you have prescriptive authority.


The surgeon seems to be taking a shortcut that compromises patient safety for his own convenience. Discuss your concerns about dangerous and legally risky practice with your nurse manager and the risk manager. The medical staff directors, credentialing committee, risk manager, and other hospital administrators should set this surgeon straight.


Your role includes assessing your patient for allergies and protecting him from potentially harmful medications. It doesn't include prescribing drugs or medical treatment. If he were harmed because you chose the wrong antibiotic, you could be named as a defendant in a malpractice suit, both for selecting the harmful medication and for administering it.