The laws and rules do not prohibit the competent and appropriately trained registered nurse from implementing a drug order that has a dosage range. The medical provider makes the "medical judgment" as to the specific medication and dosage. The registered nurse is given the latitude to use "nursing judgment" in determining the amount to be administered based on the patient’s clinical status. The registered nurse must apply adequate knowledge and skills in determining the dosage to be administered at any given time. Appropriate documentation of a focused patient assessment and evaluation must substantiate intervention. It is recommended that medication orders be patient/condition specific even if prescribed pro re nata (PRN), when needed. This would take away some of the notion of the nurse "prescribing" the medication. There should be some consultation with the physician to initiate a standing order particularly if the signs/symptoms are deviations from the patient's norm. Standing orders are certainly not to be used in lieu of medical consultation or intervention. Range orders should ideally consist of:
- The full name of the medication being ordered;
- The total amount of medication to be given in a specified time period;
- The order should state if the dose can be given in divided doses;
- The order should state if the dose can be repeated;
- If repeated, the order should indicate how frequently, and in what time frame; and
- The order should include what action should be taken if pain is unrelieved