I am a house call NP. One of coworkers just quit. I do not know what's going on. I only knew she quit because another coworker told me. My company keeps sending her orders to me such as medication refills and DME orders. The company made us to cover each other when one was on vocation. I do not want to sign orders for her patients because I do not know her patients at all. We have a medical director. Thanks for advice.
Well, if you don't want to do it, then just say no. Tell them to send the orders to the medical director to sign, or else, do what is needed to become familiar with her patients. Somebody has to sign those orders. If you were ok with signing her orders when she was on vacation, why not just treat this as a permanent vacation? The situation bears some discussion with the practice owners for a long-term solution until they hire a replacement.
I would not sign them either. I'm in a large practice and we do not sign each other's orders unless its an emergency. We do refills of needed meds but we do not refill each other's narcotics unless we know the pt.
I would contact the medical director
For me it would depend on my comfort level with the order and the accessibility of the patients chart. The company has a responsibility to the duty that they've established with the patient until that duty has changed to another provider. But, that provider has a responsibility regarding the healthcare of the patient.
Chronic refills should be continued unless it puts the patient in harm's way. Medications require different levels of monitoring. I would insist on a face to face visit if there has not been one within 6 months, with patients that require house call providers. Chances are that they have a much higher level of comorbid conditions. Other meds that would require closer monitoring, such as DM meds, I'd see them at least every 3 months.
I've refilled controlled substances that are for chronic conditions, that I have verified and documented on, if the patient has had a recent face to face. Otherwise, and for any acute fill, I would have to see first.
Most DME would just need documentation first before I'd order it, such as a cane for abnormal gait or glucometer for a DM patient.
It really depends on the situation. I take call for a large managed care company and routinely order medications for patients that I've never seen. But, I don't if there is anything that needs a face to face. Knowing that depends of you comfort level as well as laws and regulations in your area.
Don't sign anybody's orders, especially medication s. That will get you into trouble. They're not yours. If you have to call a nursing lawyer and find out.
I think somebody has to provide the continuation of care. I always read previous notes if I'm unsure but I generally refill medications . I also provide refills for narcs for the mds and pa on my immediate team. We are all conservative prescribers and follow the letter of the law. If there aren't red flags , and they are up to date on 90 day visits I generally refill while they are out of the office
In my practice we sign for each other all the time. it is usually refills, rehab referrals and oxygen. Did not even think of it as an issue.
Its only an issue if you are called into court.
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