Nurses Refilling Prescriptions

[Garden]

Hello ??

I am a Michigan Nurse and for most of my career have worked in the hospital. Most recently I have started to work in a specialty clinic. In this clinic, the physician will delegate the ability to write orders under their name. Patients are given prescriptions for one month at a time due to the medication being weight based. So patients call every month to get a new refill. The nurse will typically get this phone call and will automatically write the order for the refill for that month and send it to the patient’s pharmacy. This order will later be sent to the provider for approval after the prescription is typically filled.

I view this as prescribing and not in the nurse’s scope of practice. When I try to find more information online, the only guidelines available are about opioids which we are not refilling.

Is it OK for nurses to authorize refills in this scenario? (I’m employed in Michigan)

[mmc51264, BSN, MSN, RN]

you're not prescribing. The order is there, it is being adjusted to pt's weight.

You are not diagnosing and choosing the med. I assume there is a protocol or algorithm in place that you are using to determine dosages based on weight.

[Garden]

Hello ??

I am a Michigan Nurse and for most of my career have worked in the hospital. Most recently I have started to work in a specialty clinic. In this clinic, the physician will delegate the ability to write orders under their name. Patients are given prescriptions for one month at a time. So patients call every month to get a new refill. The nurse will typically get this phone call and will automatically write the order for the refill for that month and send it to the patient’s pharmacy. This order will later be sent to the provider for approval after the prescription is typically filled. Is this process OK?

[JKL33]

The thing is, there's really no reason it has to be done that way and the problem (besides being a patient safety issue and also probably technically illegal) is that if there's ever a situation where the provider is looking at the order after the fact and realizes it a refill probably shouldn't have been authorized for one reason or another, they might cause trouble over signing it, or say they never authorized the refill and refuse to sign it. They could try that; not to say they will. It just puts you in a bad position.

Here's a sort of similar situation (although in this case the meds were refilled by a policy that included a "standing order" to refill meds).

OP, why must the patients go through this every month? What kind of meds are we talking here?

And, no, in reality the doctor cannot delegate prescribing authority to you under the pretenses that s/he will "cover" you (sign for it later). You cannot prescribe medications under your name or anyone else's. It is outside your scope of practice. I would advise obtaining a proper order to refill for each of these instances--and if that's going to be done then the physician might as well be messaged through the practice's EMR and s/he can enter the order for the refill.

[Garden]

Thank you for the feedback.

This is for a Hemophilia Clinic. Medications are weight based so the monthly refills keeps track of the patients weight and the potential for dosage change. This also keeps track of any bleeds the patient may experience. If the patient has had any recent bleeds/weight changes THEN the provider is notified and involved in the refilling process. Otherwise if the patient had no recent bleeds or any weight changes the medication is then refilled by the RN but the physician is not involved until it is already ordered. Thoughts?

[Rose_Queen, BSN, MSN, RN]

Duplicate threads merged.

[toomuchbaloney]

My experience in Michigan suggests that there are standing orders which outline what the prescription should be according to the known and measured criteria. The RN is prescribing nothing, only executing the physician orders according to the assessments and judgements which are well within the professional duties of the license.

Please look for the standing order set.

[dream'n, BSN, RN]

Isn't this kind of what Coumadin Clinic nurses do? They see or speak with the patient, get an INR, and adjust the anti coagulant dosage if needed based upon set criteria. The provider is only notified for problems or questions.

[JKL33]

1 hour ago, toomuchbaloney said:

My experience in Michigan suggests that there are standing orders which outline what the prescription should be according to the known and measured criteria. The RN is prescribing nothing, only executing the physician orders according to the assessments and judgements which are well within the professional duties of the license.

Please look for the standing order set.

With the clarification made available via thread merging, I agree.

[CharleeFoxtrot, BSN, RN]

7 hours ago, dream'n said:

Isn't this kind of what Coumadin Clinic nurses do? They see or speak with the patient, get an INR, and adjust the anti coagulant dosage if needed based upon set criteria. The provider is only notified for problems or questions.

Exactly my thoughts. I work in a practice in Michigan and the coumadin dosing is done by nurses with some extra training. They have specific parameters and of course ask the doctor for guidance when needed. They are acting under a standing order set.

[kp2016]

10 hours ago, Garden said:

Thank you for the feedback.

This is for a Hemophilia Clinic. Medications are weight based so the monthly refills keeps track of the patients weight and the potential for dosage change. This also keeps track of any bleeds the patient may experience. If the patient has had any recent bleeds/weight changes THEN the provider is notified and involved in the refilling process. Otherwise if the patient had no recent bleeds or any weight changes the medication is then refilled by the RN but the physician is not involved until it is already ordered. Thoughts?

The key to this situation is written standing orders. As long as you have a very clear standing order / policy this is fine. You are gathering a recent nursing history and implementing the Doctors orders based on clearly defined parameters. Any situation that falls outside of the written parameters should be referred to the Doctor for review.

I have worked in many units where the nurses ordered laboratory tests or gave patients instructions to withhold X medication for Y number of days prior to a given procedure. We had a very clear written policy with parameters for orders and for medications. It was laminated and beside our computers / phone lines for easy access. If your clinic doesn't have laminated cards at your work station consider working with your manager/ educator to make it happen.

[JKL33]

^ Agree, and in no instance should any of this be thought of as ordering something under someone else's name. That isn't really what is happening (thankfully). ??