Orders for recurring IM injections in FP clinic

[bmarjie1]

There is some debate in my office right now regarding what is needed for an order for recurring injections (i.e. B-12, testosterone, Depo-provera, etc.). I work at a 10 provider, independent, Family Practice office. At this time there is not a routine process for this. The most used way for ordering these injections is to place a prescription on patients med list. The patient then makes a "Nurse Only" appointment to come in for injections? My concern about this is that although the prescription includes medication, dose, route and frequency, it does not state that medication is to be administered in the office or a duration for the order (or a diagnosis/icd-9/10 that we need when administering). My thought process is that if a patient just walked into the clinic and had Lisinopril on his/her medication list, I could not place the Lisinopril in his mouth without an order to administer, so does it count as an order for me to administer an IM injection? I am wondering what the legal/correct answer is for this as I am getting some resistance when stating that I think we need more of an order. Maybe I am just being over cautious? Does the prescription on the med list cover us to administer IM injections in the office or do we need more specific orders to administer in the office and a duration for the order since we are an outpatient, PCP office. I would appreciate any feedback on this since I would like to make sure that our office is being compliant with standards and have not been able to find a clear, defined answer.

Sincerely,

Marjie

[featherzRN, MSN]

We have an EMR that allows the provider to state "B12 1000mcg SQ/IM every four weeks" **to be administered at clinic**. That said if a patient walks in with his neupogen injection and states he doesn't know how to give it to himself, we can certainly give it if there's a valid order for him to have it. He'll be booked into a nurse clinic and we'll ask for the order to be changed to read similar to above.