Legality of signing refill requests?

[Beanyamean]

This has been bothering me, so I have decided to pick the brains of the almighty allnurses.com group. My clinic now uses an EMR system including RX refill requests. This is how it is currently set up:

1- RX refill request comes in (fax, phone call, pt shows up, ect)

2- RN/LPN/MA enters request into electronic system

3- RN decides on quantity, number of refills, SIGNS the refill request according to protocol (current labs, recent visit, ect)

4- RX is sent to pharmacy

The physician is not involved unless it is a narcotic or the pt needs labs or falls outside of the "protocol." I am not involved in this process as I work in the urgent care/ER sector of the hospital. I am just curious what everybody thinks about this. Does this fall outside of the scope of practice? Is this considered prescribing? Obviously if you can call a refill in this should be a legal practice, but it is difficult to explain why it seems wrong. probably because I have overheard at least one clinic nurse talk about trying to authorize narcotics, which the system did not allow them to do. This practice was developed because it was too time consuming for the providers to deal with the volume of refill requests received daily. I am mostly concerned because we are getting a JCAHO visit in a few days. What do you guys think?

[Esme12, ASN, BSN, RN]

Nurses call in prescriptions all the time under the MD direction. Even though the MD doesn't appear to be involved...they are.....the pharmacy keep track and the MD has to ultimately approve the script. If the nurse is acting on protocol it is under the physician orders. New laws prevent a nurse from filling narcotic refills this way and the nurse that tried needs to stop.....she is not allowed and is putting herself/the clinic and the MD in harms way.

Since this is not your area.... what is your involvement in this? What does the Joint Commission survey have to do with you and what are your concerns?

[Beanyamean]

I guess I just don't see how the MD,PA,NP is involved. I will give an example. I was out of a PRN med I take. I walked over to the nurse of my PCP. I asked the nurse for a refill, The nurse said "sure" typed in my info and refilled my benzo script. My concern with the audit is our hospital is small and they tend to ask all of us about P&P and I want to be able to justify my answer, and of course there are postings all over the walls. Just get the feelings something isn't right. Also, I occasionally get a refill request come across my desk but they are handled a little differently than the clinic, more like the old fashioned way. I am just looking out for my friends on "the other side."

[Esme12, ASN, BSN, RN]

How things are in the clinic are different than the PCP office. That nurse is authorized to make an electronic prescription as ordered by the MD as depicted by policy and procedure. Office staff do this ALL the time. If you want to know what that process is ask your PCP. The JC will not ask you how your PCP fills you scripts...... they will ask you about your department and YOUR compliance.

The JC doesn't expect every employee to know ALL policies by heart......but they do want to know you know where to find it. Your PCP office is responsible for their own actions..... not you just because you work king the same building. Don't look for things that may not be there and aren't your responsibility. Is this your first JC survey? ...if you think something isn't right...talk to your PCP. OR talk to your boss about your concerns.

[nurseprnRN, BSN, RN]

The primary prescriber side is addressed, specifically, by the fact that there are developed and approved protocols for RNs to write the requests for refills. If they aren't written for opioids (and I'm actually surprised they are written for benzos), that's appropriate.

[classicdame, MSN, EdD]

may depend on your nurse practice act. I used to work for MD's and would only call in RX refills if MD had clearly written these were allowed. It is still a medically delegated act

[nurseprnRN, BSN, RN]

may depend on your nurse practice act. I used to work for MD's and would only call in RX refills if MD had clearly written these were allowed. It is still a medically delegated act

Th protocols constitute "delegation," but I think the RN is still obligated to use some professional judgment about when to contact the physician about any given refill about which there could be a concern.

[Beanyamean]

I figured with most of the maintenance meds that this is not a problem at all. There is what I consider a "shady" standing order/policy authorizing refills. Controlled substances I am still not comfortable with. My concern with JC is that I am technically grouped with the "clinic" as we are a rural hospital. It's difficult to explain, but JC is within their right to ask me about polices for the clinic side. I occasionally float to the other side to help out but am not trained to do their med refills. Ours are just handled differently because our patients are not chronic. I care deeply about my hospital and would hate for anyone to get into any kind of trouble, let it be a provider, RN, support staff, or the facility itself. We provide a great deal of care for our small community and we are all the community has. I am just the type of person that checks the drug book, online reference, and with an RN before I administer a new med I have never used before. I document very well, check out dates constantly, stay current on my CME, ECT. I am sort of anal. I am not out to get anyone in trouble. I just like to look out for my friends as the facility I work for can be pretty...difficult at times. Thank you everyone that has responded.

[Esme12, ASN, BSN, RN]

Call your pharmacy at your facility and ask the pharmacist. Call your PCP and ask them. Look up your policies at work. If you are floated there are you ever asked to perform this skill....calling in scripts? If so..... then you do need to know the policy of YOUR FACILITY. Call your state BON and ask what the rules are...or...look them up online. As long as the MD at the end of the day signs the electronic scripts...it's legal. This varies state to state with stiff regulations in some states about narcs/benzo's requiring the MD only...but in other states this isn't the case....so it is difficult to answer your question correctly. Trust me the state and the DEA monitor this stuff.

While I understand your desire to want your facility to do well....my question is....Is it your responsibility? Many facilities even small ones...have behind the scenes mock surveys where the pay the JC consultant to come in and do a preview survey so glitches can be found and corrected. Even if the JC sees something wrong all they as for a corrective action be submitted on how the situation/deficiency will be improved/changed and schedule an earlier visit.

Are you management/administration? or staff. I guess what I'm saying is....if you aren't management or administration.....worry about yourself and your responsibilities...there are other people that are paid to worry about the bigger picture and other departments. Concern yourself with your responsibilities.= is my best advice.

Breathe....the JC don't bite....well at least not very hard....((WINK)) Relax!

[meandragonbrett]

I fail to see where this is your responsibility.

[Beanyamean]

I fail to see where your response is helpful in the least.

[chare]

My concern with JC is that I am technically grouped with the "clinic" as we are a rural hospital. It's difficult to explain, but JC is within their right to ask me about polices for the clinic side. I occasionally float to the other side to help out but am not trained to do their med refills.

You aren't expected to know every policy that your facility has. If you occasionally float to the clinic you should be aware of the clinic policies that pertain to you. If you do not participate in this practice, however, then this policy does not pertain to you. If one of the surveyors does ask you about this all you need to do is explain this to them.