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
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
May 29, '07
Thanks for the imput! And the article... it is a good one and I've read it before. The office is a primary care office and the refills run across the spectrum of meds. We use an electronc medical record and labs often include comments from the PCP about when to recheck, med dose changes etc. So in a sense there is an individualized patient protocol.
Prior to this new change, the nurse was responsible for reviewing labs and any pertinent comments therein and following up with patient if CBC, for example, was not rechecked in 3 weeks as ordered... We would also review the last office visit note for plan of care and any pertinent notes for follow up, "continue meds", and make sure the patient did indeed follow through with the plan. If anything was amiss the nurse would call the patient, reiterate previous plan, notify the PCP and ask what to do about the refill. The old process required diligent research and judgment on the part of the nurses and opportunities for clarifying with the PCP were always there if anything was out fo the ordinary.
The only difference now (we are still doing all this research), is we have to write it all down and send to the PCP for authorization which takes DAYS sometimes. The nursing judgment and critical thinking has been removed. Especially when the Rx is for Doss or APAP.