HUNTINGTON MEMORIAL HOSPITAL

DEPARTMENT POLICY & PROCEDURE

DEPARTMENT: ADULT RESPIRATORY SERVICES

SUBJECT: COMPLETE ORDERS POLICY Page 1 of 3
NO: 7720.1105
APPROVAL: Vice President and CNE EFFECTIVE DATE: SUPERCEDES/
1 February, 2007 REPLACES:
1 Feb, 2003
AUTHORIZATION: Medical Director

PURPOSE
To ensure appropriate, accurate Respiratory Therapy orders in response to a physician’s order in
compliance with Huntington Hospital policy.

POLICY
I. All services rendered must have a written prescription on the physician order sheet.
II. In most cases orders must be complete before therapy can be instituted.
III. The physician will review all written orders every 72 hours for reassessment of need.

PROCEDURE

I. PERSONNEL
A. Respiratory Care Practitioners (RCP)
B. Student affiliates and/or new employees under the direct supervision of a Respiratory
Care Practitioner.

II. CONTENT
The requirement that constitutes a complete order depends on the type of therapy ordered.

A. OXYGEN THERAPY
Oxygen Therapy needs to specify
1. type of device
2. liter flow
3. FI02 (as applicable) or
4. Sp02 range.

B. NON-PRESSURIZED AEROSOLS AND IPPB

Non-pressurized aerosols and IPPB need to specify;
1. type of device
2. medication
3. dose of medication*
4. frequency
5. duration*
6. diluent*.

NOTE: *May fall within department guidelines/service protocol.

SUBJECT: COMPLETE ORDERS POLICY NO:7720.1105 Page 2 of 3

C. NON INVASIVE VENTILATOR ORDERS

Non invasive ventilator orders need to specify;
1. mode
2. set IPAP level or range
3. set EPAP level or range
4. frequency
5. rate.
6. ventilator variables to initiate or manipulate in order to achieve desired blood
gas results.

D. CONTINUOUS VENTILATOR ORDER

Continuous Ventilator order needs to specify:
1. mode of ventilation
2. set ventilator frequency
3. set pressure support level
4. peak inspiratory pressure limit
5. set FIO2 – range
6. minute ventilation
7. set I.E. ratio – percent inspiration, or inspiratory/expiratory time
8. set tidal volume
9. peak, mean, and baseline airway pressures as applicable
10. Or follow protocols for desired range for Pa02, PaC02, Sp02 or Sa02.
Ventilator variables to initiate or manipulate in order to achieve desired blood
gas results (i.e. mode, tidal volume, airway pressures, ventilatory frequency or
FI02. Medication, if any, with dosage, frequency, duration and diluent.

III. INCOMPLETE ORDERS:

An incomplete order may fall into one of the following categories:
A. Incomplete orders that require physician clarification before initiation of therapy.
B. The order is missing a vital component that can only be completed by a physician
either through a telephone or written order. If a vital component(s) is missing,
proceed as follows:
1. Do not give the therapy until such time that the order has been clarified;
a. an exception to this would be if the patient is in extreme respiratory
distress and the only missing component is the frequency of the
treatment. In this case the treatment can be given with the consent of
the nurse as a one-time order; another treatment cannot be given until
the physician clarifies the frequency of the treatment.
b. If ventilator orders are incomplete, ventilatory support can be initiated
based upon the current post operative open heart order set until a
physician can be contacted.
2. Notify the nurse of the incomplete order and that therapy cannot be initiated
until missing information is obtained.
3. Contact the physician who wrote the order and obtain an order that will
complete the prescription or if not available proceed as follows:
a. Call the resident on service of ordering physician.
b. Call resident on Pulmonary Service if resident on original physician’s
service is unavailable.
SUBJECT: COMPLETE ORDERS POLICY NO:7720.1105 Page 3 of 3

c. Call the Medical Director or the physician on call for the Medical
Director.

IV. INCOMPLETE ORDERS THAT CAN BE COMPLETED BY A SERVICE PROTOCOL

The order contains the medication, dosage of the medication, and the frequency of the
treatment; however, the order is missing one of the components listed below. In this case,
the treatment can be give using the following guidelines:
A. When duration of treatment is not ordered, treatment will be given for 10 to 15
minutes.
B. When diluent is not specified, 3 cc’s of normal saline will be used.

V. DOCUMENTATION:
The appropriate PCS Form. Document the incomplete order in the patient’s medical record,
whom you notified, time, missing information noted, and procedure delay if applicable.

SOURCE:
PCDM

REFERENCE:
I. Egans Fundamentals of Respiratory Care, 6th Edition, page 736
II. AARC Guidelines