Everywhere I've worked and known of has this system: There are protocols and standing orders in place for routine and maintenence meds with parameters for refills such as how often certain labs are to be checked, etc. If patient is current on labs and office visits it's all good for a nurse to fax/phone a refill of a non-narcotic med (narcs require approval from prescriber first).
Well, a certain board of pharmacy has decided this is not acceptible practice in our office any longer. This was not due to an error on behalf of a nurse authorizing refills based on our protocols, they just "found out" and are cracking down - apparently. Well, This requires every single refill request to be approved by the PCP prior to the nurse faxing it. WHAT EVER!!! Totally lame. I am all over patient safety, medication safety, really, I am into it... but THIS? It turns a previously 24 hour turn over for refills into 4-5 days. Poor patients!
May 29, '07
by NRSKarenRN, BSN, RN Moderator
think instead of standardized office protocol, they are looking for standardized individual patient protocol.
suggest that you develop standardized form based on same info already have in office protocol that can be kept in each patients chart listing dx requiring anticoagulation and protocol desired, extra space for specialized order, have md sign and review periodically by doc (minimum yearly). md's should sign off on lab results to show reviewed and periodically note "continue med protocal".
run that form up the flagpole er past pharmacy board and should past muster.
good article for review/info to consider:
warfarin therapy: evolving strategies in
Last edit by NRSKarenRN on May 29, '07