Safe IV solutions; supply storage; indicator strips; recommended practices; latex; physicians' orders - Clinical Issues

AORN Journal, Oct, 2001 by Ramona Conner

Answer: The US Food and Drug Administration has issued new latex labeling requirements for manufacturers. The regulation states,

   Devices containing natural rubber latex that contacts humans ... shall bear
   the following statement in bold print on the device labeling: "Caution:
   This product contains natural rubber latex which may cause allergic
   reactions." This statement shall appear on all device labels, and other
   labeling, and shall appear on the principal display panel of the device
   packaging, the outside package, container or wrapper, and the immediate
   device package, container, or wrapper. (8)

Question: What does AORN recommend for documenting physicians' oral and standing intraoperative orders? Can the preference list be used as documentation of standing orders? Should the surgeon sign the surgical record or a physician order form to cover what was performed intraoperatively, or is the preference list acceptable for documentation? I was told preference lists are not accepted by the Joint Commission as documentation of surgeons' orders.

Answer: We frequently receive similar questions regarding the use of preference lists and physicians' standing orders. The Joint Commission does not have a standard addressing the use of physician standing orders or OR preference lists and does not survey this issue. (9)

Third-party payers, however, often have strict documentation requirements and may not reimburse for items that are not properly documented. Surgeons' oral orders should be documented either on a physician order form or in the surgical record. Oral orders should be documented on the physician order sheet in the same manner throughout the facility. There should be one policy and procedure for documenting physician oral orders that is followed consistently in every department.

Surgeon preference lists can be used as documentation for routine orders; however, the facility should have a routine for individual surgeon review of these "standing orders." Most facilities require an annual or semiannual review with the surgeon signature on file in the OR. The facility also should have a policy and procedure for updating and revising preference lists to include a requirement for a surgeon's signature. Another acceptable approach is to place a copy of the preference list or standing orders on the chart for the surgeon to review and sign later. With either method, it is the facility staff members' responsibility to determine the policy and procedure for documentation of oral and standing orders, including the use of preference lists.

NOTES

(1.) L Fitzpatrick, T Fitzpatrick, "Blood transfusion: Keeping your patient safe--how to prevent transfusion reactions and other hazards," Nursing 27 (August 1997) 37.

(2.) American Association of Blood Banks, "Circular of information for the use of human blood and blood components," http://www.aabb.org/all_about_blood/coi /coiv2.pdf (accessed 17 Aug 2001).

(3.) "3.3.1 Space requirements" in American National Standard, Good Hospital Practices: Steam Sterilization and Sterility Assurance (Arlington, Va: Association for the Advancement of Medical Instrumentation, 1993) 13.