Home Health & Hospice

Standardized Protocols, Not Standing Orders

Homecare Insider, November 30, 2009

Homecare providers are exploring ways to implement the evidence-based practices (EBP) in OASIS-C.  One idea:  standing orders.  According to the medical dictionary, a standing order is a written document that contains rules, policies, procedures, and orders for conduct of patient care in stipulated situations.  Standing orders identify the actions to be taken, including the dose of a medication or other treatment, for a given condition.  That’s not a bad idea but it won’t work in home health care.  
The Conditions of Participation say that staff administer medications and treatments only as ordered by the physician.  Because of the increased interest in standing orders for EBP, the Centers for Medicare and Medicaid Services (CMS) released a statement in December 2008.  “Standing orders violate the intent of the regulation that physicians, not nurses, establish the plan of care for an individual patient.”  

However, that memo did not ban standardization as a way to address EBP.  CMS said, “We encourage home health agencies to develop protocols of care and discuss these protocols with the physician when developing or altering the plan of care for a specific patient.  However, the inclusion of a particular protocol in the patient’s plan of care must be based on existing problems or needs of the individual patient.”  

A protocol blends policy and procedure into a standardized written plan specifying actions staff should take when providing care in a specific situation.  Once developed, a clinician can discuss with the physician how to adapt the protocol to a patient.  The physician approves the protocol with necessary modifications and the clinician incorporates that into the patient’s plan of care.  

When looking for ways to be efficient in the PPS, think standardized protocols that become specific patient orders.  You’ll gain the benefits, e.g., efficiency, of standing orders while maintaining compliance with the homecare regulations.

The audio conference on December 17 will discuss OASIS-C and the agency’s operations.  Click here to learn more about this educational program.