A sound understanding of the principle of

safe medication management is essential for

all nurses, midwifes and health agencies
involved in the care of patient, residents and
clients.
A standing order is a document containing
orders for the conduct of routine therapies,
monitoring guidelines, and/or diagnostic
procedure for specific client with identified
clinical problem
 Standing Orders are
ord
ers in which the nurse
may act to carry out
specific orders for a
pa
tient who presents with
ddressed in the standing
orders. They must be in
written form and signed
and dated by the Licensed
Independent Practitioner.
 Examples of situations in which standing orders may be
utilized can include,

◦ Administration of immunizations (e.g. influenza,

pneumococcal, and other vaccines)
◦ Nursing treatment of common health problems
◦ Health screening activities
◦ Occupational health services
◦ Public health clinical services
◦ Telephone triage and advice services
◦ Orders for lab tests.
◦ School health
◦ During labor.
 To maintain the continuity of
the treatment of the patient.
 To protect the life of the

patient.
 To create feeling of

responsibility In the members

of health team
 Providing treatment during emergency
 Enhance the quality and activity of health

service.
 Developing the feeling of confidence and

responsibility in nurses and other health

workers.
 Protecting the general public from

troubles.
 Enhancing the faith of general public in

medical institution.
All IV and controlled drug must be checked by two
midwives.
 ANALGESIA- Paracetamol 1gram as a single dose,
once only
 ANTACID-Maalox suspension 10ml as a single
dose
once only
or
Peptac liquid 10-20ml as a single dose
once only

 LAXATIVE- Ispaghula Husk 3.5g one sachet in water

once only
 IN ELECTIVE LSCS theatre. Sodium
Citrate 0.3mg 30ml orally once only
immediately prior to transfer to Theatre

 I.V. THERAPY Compound Sodium Lactate 1

litre i.v. over 8 - 1 2 hours, to a maximum of
two liters

 Heparin 10IU/ml 5ml instilled into

i.v. cannula When required every 4 - 8
hours
 LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml intradermally prior to
cannulation once only or Amethocaine gel 4% 1g 45 minutes prior to
venous cannulation once only

 NIGHT SEDATION -Temazepam 10mg as a single dose up to

2.00am in the morning.

 DINOPROSTONE VAGINAL GEL-As per induction of labor guidelines.

 FOLIC ACID -Folic acid 400microgram tablet once daily, until 1 2 -

1 4 weeks gestation.

 DEMULCENT COUGH-Simple linctus 5ml once only PREPARATION

 ANTISPASMODIC-Peppermint water 10ml in plenty of water, once

only.
 ANTI –D IMMUNOGLOBULIN
Anti-D immunoglobulin may be given to
all non-sensitized Rh D negative women within 72
hours of a sensitizing event in the following
circumstances
Prior to 20 weeks gestation Anti-D
250iu by I.M. injection. The following
conditions are:
 Threatened miscarriage after 12 weeks
gestation
 Spontaneous miscarriage after 12 weeks
gestation
 Ectopic pregnancy
 Therapeutic termination of pregnancy – medical
and
 After 20 weeks gestation Anti- D 500i.u. by I.M.
injection
 Ante partum hemorrhage
 External cephalic version
 Intrauterine death
 Invasive prenatal diagnostic and intrauterine
procedures
 Blunt abdominal trauma

 Routine Ante-natal Anti-D prophylaxis

Anti-D 500i.u. by I.M. injection at 28 and 34
weeks gestation
 -Entonox inhalation as

ANALGESIA
required
 ANTI-EMETICS-Cyclizine 50mg I.M. every 8
hours as required to a maximum of
150mg/24 hours
or
Metoclopramide 10mg I.M.
every 8 hours as required to a maximum of
30mg in 24 hours or 500 micrograms per
Kg in 24 hours for women<60kg
 ACTIVE MANAGEMENT-Oxytocin 10 i.u.as per
unit policy OF LABOUR
or
Syntometrine 1ml I.M. with
anterior shoulder at delivery

 I.V. THERAPY -Compound Sodium Lactate

1 litre I.V. over 8 - 1 2 hours as required to a
maximum of 2 litres

Heparin 1 0 u / ml 5ml instilled

into
I.V. cannula every 4 - 8 hours when required
 LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml
intradermally prior to cannulation, once only

Amethocaine gel 4% 1g prior to

cannulation once only

 LAXATIVES-Glycerine Suppository 1 or 2 per

rectum
or
Docusate sodium 90mg micro
enema as required
 EPISIOTOMY-Lignocaine 1% 10ml by
perineal infiltration.
PAEDIATRICS
The following may be administered to
babies after delivery without
reference to Paediatric staff:
 Oxygen by facemask
 Phytomenadione 1mg by I.M. injection
 EPISIOTOMY REPAIR -
Lignocaine 1% by perineal
infiltration to a maximum of 20ml

 ANALGESIA -Only one NSAID

should be prescribed at any one
time
Caesarean Section for first 24 hours:
Anaesthetist will be responsible for
analgesia. Unless contra-indicated
diclofenac suppository 100mg will be given
rectally in Theatre. One dose of an NSAID
can be given 1 4 - 1 6 hours after the
suppository. If Diclofenac is given, the total
dose must not exceed 150mg by all routes
in any 24 hours period.
 Vaginal delivery or Cesarean Section after
first 24 hours:

 Ibuprofen tablet or syrup 400mg or 600mg

three times a day.

 Diclofenac tablet or suppository 50mg three

times a day (to a maximum of 150mg in 24
hours by any route).
 PARACETAMOL -Only one paracetamol based
analgesic should be prescribed at any one
time.

Paracetamol 1gram every 4 - 6 hours to a

maximum of 4grams in any 24 hours as
plain or effervescent tablets or rectally as
suppository.
 ANTIEMETIC- Cyclizine 50mg I.M. every 8 hours
as
required to a maximum of 1 50 mg /2 4 hours.

 LAXATIVES-Ispaghula Husk 3.5g, 1 sachet in water

twice daily

Lacunose 10ml orally twice daily

Glycerine suppository 1 or 2 per
r ec tu m as r e q u ir
ed
 HAEMORRHOID-Anusol cream apply twice daily
and after each preparations bowel movement

leared
 I.V. THERAPY Compound Sodium Lactate 1
litre
I.V. every 8 - 1 2 hours as required to a maximum
of 2 litres

 Heparin 1 0 u / m l 5ml instilled into I.V. cannula

every 4 - 8 hours when required
 LOCAL ANAESTHETIC-Lignocaine 1% 0.1ml
intradermally prior to cannulation, once only
Amethocaine gel 4% 1g
prior to venous cannulation once only

 ANTI –D -Anti-D Immunoglobulin 500i.u or

more. by I.M. injection to Rh D negative women
with a Rh D positive baby within 72 hours of
delivery as per obstetric unit guidelines.

 VACCINES -Rubella vaccine (live) 0.5ml

by deep subcutaneous or intramuscular
injection if mother not immune.
 IRON SUPPLEMENT -Ferrous sulphate
tablet 200mg three times a day if
haemoglobin below 10g/dl.

 DEMULCENT COUGH-Simple linctus 5ml 3 - 4

times a day preparation

 ANTISPASMODIC -Peppermint water

10ml in plenty of water once only.