Nurses use of Standing Orders/Protocols for the Administration, Prescribing, and Dispensing of Medications to Students in a College Health Setting

A request was received for an opinion on the following questions:

1. A student presents with nausea and vomiting.  The standing order would allow the nurse to administer one dose of Phenergan 20 mg, PO or IM depending on the severity of the symptoms.  The medication would only be given after the RN completes a subjective and objective assessment, ruling out conditions such as right lower quadrant pain that would need assessment by a physician.  However, each year we see hundreds of cases of viral gastroenteritis, and in this instance, rather than call the physicians multiple times every day, the standing order would allow students to begin a medication to relieve their symptoms.  A prescription for further doses could then be called in after consulting the physician as described above.
   
   
2. What about standing orders to give vaccines and TB tests?  The specific vaccines we administer are MMR, Menomune or Menactra, Tetanus-diptheria, Hepatitis A and B and, of course, Flu shots.  TB tests are requested by students volunteering in settings requiring this.  Again, many of these students may not have been seen by the physician as in their private practice.
   
   
3. A student brings in a written order from a private physician for the one-time administration of medication, such as Depoprovera IM.  This is an order to administer medication, yet not by the college physicians.
   
   
4. Our physicians think it would be fine for us to call in refills of prescription allergy medications, specifically antihistamines such as Zyrtec, and nasal sprays such as Flonase.  As long as they sign the chart the next day, would this be allowed?

Following review of the questions, statutes governing nursing practice, and the Scope of  Practice Determination Guidelines, it was the advisory opinion of the Board that it is within the scope of RN practice, for the RN who possesses the requisite education and clinical competency to perform acts as stated in question #1.  The nurse should provide the patient with applicable education and advice for follow-up treatment.

It is within the scope of RN practice to perform the acts as stated in question #2, using an established medical standing order/protocol and under the statutes and administrative regulations governing the administration of immunizations as issued  by the Cabinet for Health and Family Services, Department of Public Health.

It is within the scope of RN practice to perform the acts as stated in question #3, and not within the scope of RN practice to perform the acts in question #4 unless the refill is authorized by the prescriber.