Standing orders enhance workforce capacity, support interdisciplinary collaboration, and improve access to treatment while maintaining safe and effective healthcare delivery.
They are commonly used in general practices, emergency departments, and by paramedics. In community pharmacy, pharmacists have long operated under standing orders to manage and adjust warfarin dosing for individual patients through the Community Pharmacy Anticoagulation Management Service.
More recently, standing orders have also supported services for common health conditions, highlighting their value in enabling pharmacists to deliver timely and accessible care.
Importantly, standing orders do not give the User prescribing rights and should not be confused with a verbal order.
They do not allow a User to generate a prescription for later signing by a prescriber, nor do they permit the use of pre-signed prescriptions.
Instead, a standing order strictly authorises the User to supply and/or administer specified medicines under clearly defined conditions.
Legal framework
In New Zealand, standing orders are regulated under the Medicines (Standing Order) Regulations 2002.
Standing orders may be used to administer and/or supply prescription medicines, restricted medicines, pharmacy-only medicines, and certain controlled drugs.
However, unapproved medicines cannot be supplied or administered under a standing order.
The contents of a standing order must meet specific legal requirements and clearly outline the clinical circumstances in which it applies, including:
- The rationale for the standing order.
- The clinical conditions or circumstances covered.
- The category of individuals authorised to administer and/or supply the medicines under the standing order. y
- Details of the treatment for the conditions covered.
- The contraindications, exclusions, precautions and red flags.
- A list of the medicines that may be supplied and/or administered, including method of administration and number of doses and frequency.
- The required level of competency for authorised Users.
- The clinical documentation requirements for patient assessments and treatment provided.
Standing orders must also be regularly reviewed and audited by the original Issuer to ensure they remain clinically appropriate, legally compliant, and are being used correctly in practice.
Did you know?
A standing order is a written instruction issued by a practitioner (the Issuer), such as a medical practitioner, dentist, nurse practitioner, optometrist, who authorises specified health professionals without prescribing rights (the User), such as pharmacists, paramedics, registered nurses, to administer and/or supply medicines under defined conditions and specific standards, without the patient needing to be individually assessed by the practitioner at the time of treatment.
Issuer duties
The Issuer of a standing order carries significant legal and professional responsibilities and is responsible for ensuring the standing order:
- Is evidence-based, clinically appropriate, and legally compliant.
- Clearly defines the circumstances in which medicines may be supplied and/or administered.
- Includes appropriate training and competency requirements.
- Has processes for regular review, audit, and quality improvement.
- Provides appropriate clinical support to authorised Users
User responsibilities
While the Issuer holds overall responsibility for the standing order itself, individual authorised Users also carry full responsibility and accountability for their actions when operating under it, including professional liability.
Standing orders cannot cover every possible clinical scenario and using them safely requires more than simply following written instructions.
Users are expected to apply sound professional judgement, critically assess the appropriateness of the patient and situation, and reflect on their own competence, training, experience, and available support before proceeding.
- Individual authorised Users must ensure they:
- Operate within their level of competence.
- Follow the standing order precisely as written.
- Obtain informed consent from the patient.
- Complete all required documentation accurately.
- Remain up to date with relevant clinical guidelines and any updates to the standing order arising from routine regular audits, reviews or adverse events.
While legislative frameworks differ internationally, the principles underpinning standing orders – safe medicine supply, governance, competency, and professional accountability – remain broadly applicable across healthcare systems.
When developed and implemented appropriately, standing orders can support pharmacists and other healthcare professionals to deliver timely, accessible, and patient-centred care within a strong framework of clinical governance and patient safety.
PGNZ has developed comprehensive guidance on standing orders to support pharmacists involved in their use, available at https://www.pgnz.org.nz/practice-guides-and-resources
