On The Quick
Standing Orders in Hospitals • National Science Exhibit Contagion Posters
STANDING ORDERS IN HOSPITALS
Recently, the Centers for Medicare and Medicaid Services (CMS) revised two directives on the use of standing orders in hospitals. The move places it back on the same page as Joint Commission, which promptly approved the shift. According to the revisions, a copy of the orders must be in the patient’s chart and include a dated signature of the practitioner responsible for the patient’s care. The latest clarification concludes that the timing of such documentation should not be a barrier to speedy and necessary care.
The two exceptions remain influenza and pneumococcal vaccines. In these cases, physician-approved hospital policy is sufficient.
The directive also sets out the guidelines for preprinted order sheets. It is no longer necessary that each page of a multi-sheet set have a signature. Rather, it’s enough for the date and signature to appear on the final page along with identification of the total number of pages. If check-off boxes are used, initials suffice for alteration and deletions.
In an additional note, CMS indicated interest in working to develop a common understanding of evidence-based best practices and what they call “important operational definitions as they pertain to standing orders,” including preprinted order sets.
The directive also encourages a “culture in which it is not only acceptable, but also strongly encouraged” for staff to bring to the attention of the prescribing practitioner questions or concerns they have regarding orders before they are prepared or administered.
CONTAGION POSTERS FROM THE NATIONAL SCIENCE EXHIBIT
Since becoming an aficionado of “Antiques Roadshow,” I look at posters with a more critical eye. They constitute a true art form, a genre that blends art with information, and you won’t find a better example than the exhibit that was recently on display at the National Academy of Sciences in Washington, D.C.
The posters come from the National Library of Medicine, but the collection includes work in several different languages — English translation provided — from Asia, Africa and Europe. The focus is public health and the scope is wide: tuberculosis, influenza, malaria, gonorrhea and HIV/AIDS, to name a few. According to its outreach manager, Alana Quinn, the PDF catalogue will be available permanently.
Go to www.nasonline.org, click on Cultural Programs, then Exhibitions, then scroll down for the title An Iconography of Contagion.
Because the posters span 50 years, 1920–1990, they capture the changing styles and shifting behaviors of the eras in which they were drawn. Linking the battle against disease with defeat of the enemy was popular in WWII; in the age of Iraq, it’s probably less so.
Changing attitudes toward some diseases is notable. Influenza was always neutral, STDs were not. An underlying theme that continues in today’s medical arena, that education thwarts contagious disease, took firm hold during these years.
The posters are funny, edgy and instructive. My favorite is a drawing of garbage crawling with vermin, with the title “The Martinique Association of Rats, Mice, Mosquitoes, Ravets, and Flies, Say to You: Thanks.” Ravets, by the way, are roaches.
This article is from workingnurse.com.