Doesn't meet criteria, what to do?

[AngelfireRN, MSN, RN, APRN]

Hi, all. Without getting into too much detail, my clinic has a program that has specific criteria that must be met for the patient to be started on the program medication. Had a case yesterday, and I'll be honest...it was a judgement call, I've not really done a great deal with this program, and I went by the book. There was no senior provider here to offer counsel, nor could they be reached by telephone.

The patient met part of the criteria, a physical finding, but with the range the finding was, it required a history (personal or family) of certain other conditions. She denied all of these on her initial interview.

When I looked at the protocol, the other provider and I decided that, since it was an "If this AND that, treat" situation, and since THAT was not mentioned, the patient did not meet protocol.

When this was explained, the patient immediately began picking conditions off the list and stating that a family member had them. Again, this was the first time these conditions were mentioned.

I later spoke to one of the senior providers about the case, and he said that, while I went by protocol, the patient could have been started on the medication, and that "I'd get used to it." This medication is considered a controlled substance, and while that's legal where I am, initiating therapy with such a gray area bothered me.

Would any of y'all have done differently.

[mammac5]

My thoughts...

If there's a protocol, we have to follow it. If a deviation from protocol is going to be made, it should be made by a supervising/collaborating provider so your hind end is covered. Any deviation from protocol should be accompanied by charting why the deviation was made and who approved it.

[AngelfireRN, MSN, RN, APRN]

My thoughts exactly, which is why I did not do it. It's easy to tell me over the phone that it's OK to do, but I doubt if something happened that that conversation would be admissable, if it were even remembered and admitted to.