My patient one day, a spry 80-year-old, started to cough and feel short of breath during a blood transfusion: classic signs of a transfusion reaction. I stopped her IV, but she needed a steroid to bring her breathing back to normal.
Unable to reach her primary physician, we called in a rapid-response team. An ICU doctor, respiratory therapist, two ICU nurses, a nurse anesthetist, and MDs and RNs from the floor all rushed into the room . . . . to authorize giving my patient this one needed drug.
The patient did not need rescuing, just a dose of solumedrol, and I could have given her that dose, without wasting the time and energy of multiple nurses and doctors, if we had a protocol, or "standing order," in place in my hospital for treating transfusion reactions.
A standing order is a kind of treatment algorithm used in hospitals to expedite care. Protocols are designed by doctors and nurses, implemented by nurses, and are typically used either in specific emergencies or to deliver routine care. A protocol for treating low blood sugar is an example of treating an emergency; putting silver nitrate in a newborn's eyes counts as routine.
Protocols make a lot of sense, according to Nancy Foster, vice president for Quality and Safety Policy for the American Hospital Association. The AHA supports the use of standing orders because, Foster says, "Standardization is an effective way to make sure we do the right thing for the right patient at the right time."
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