At the urging of the AHA and others, the Centers for Medicare & Medicaid Services last week issued revised interpretive guidelines clarifying that standing orders and written protocols for drugs or biologicals may be used in hospitals. Memoranda containing the original guidelines were sent to state survey agency directors earlier this year. In a letter to CMS, the AHA warned that the original language was counter to accepted standards of care and would impede hospitals’ progress on quality improvement initiatives and could lead to patient harm. Among CMS’ clarifications, the agency said that standing orders should be written in the patient’s chart and signed by the practitioner responsible for the care of the patient, but that the timing of such documentation should not be a barrier to effective emergency response, timely and necessary care, or other patient safety advances.