The issue of standing orders and IV clinics is fact dependent and varies by state. You have to first understand the scope of practice of the providers and then the supervision requirements fall in behind.
In Florida, APRNs, PAs and RNs can administer IV with some level of off-site/in-direct supervision by a licensed physician. Generally, an APRN and PA have authority to conduct an initial patient exam, diagnose, prescribe and then administer treatment to patients. RNs, however, do not have the same scope of practice or powers. Instead, they rely largely on physicians for authority and direction. They can, however, operate without direct supervision. This creates some confusion and gray area over how standing orders can apply.
Standing orders are generally reserved for less invasive and contained treatments. IV therapy generally falls under an appropriate use for standing orders. A physician should prepare a set of strict guidelines for when a RN can administer IV without a patient first having a detailed exam by the physician. Think, “if this, then that”. The protocol should have contraindications listed which would require further follow up if needed, or prohibit the treatment entirely. Standing orders are not really meant to displace the typical initial patient examination, although in the IV therapy world, they generally have.
Clinics and providers should seek further guidance when compounding or providing additional services with the IV therapy.
