Can a nurse suggest a prescription device to a patient?

[mlkls13]

I am an RN, but currently I work for a DME company, a device that is available by prescription only. My supervisor is suggesting we ask bedside nurses and case managers to identify patients who qualify under FDA/MCS criteria for the DME device, provide the patients who qualify with a brochure, and have the patient ask the physician about it.

As a family member or patient, I would want to know if there was something available that could be life-saving. However, as an RN, I would not be willing to do this. I wouldn't provide a patient with information about a drug I feel they should receive and tell them to ask their doctor. And because this DME device is available only by physician prescription, I would feel the same. Yes, there are commercials for medications that say "ask your doctor to prescribe...", but those commercials have regulations they must follow in order to advertise. I feel like suggesting something to a patient which must be prescribed might cross the line of "practicing medicine", or "diagnosing the patient". I wouldn't say "you're anxious, ask your doctor for Xanax", or "you can't concentrate, ask your doctor for Adderall", or "your blood pressure is high, ask your doctor for Metoprolol", because that would be diagnosing and suggesting treatment. I would have no problem bringing it up to the doctor, but I would never bring it up to the patient.

I plan to call the state nursing board to ask, but I'm just wondering your thoughts? Am I over-reacting?

[JKL33]

Sounds slimy.

If I understand correctly, your boss wants you to go into rooms of patients whom staff members suggest might be able to use your services so that you can ask them to request an order for your product from their physician.

People will be in HUGE hot water for giving you names and PHI of "appropriate" patients so that you can go and essentially solicit them without there being any order or request for DME. If your company has not been consulted to provide a service for Patient XYZ, that would be a HIPAA violation. Not to mention I'm pretty sure your company can't just solicit the captive audience that is hospitalized patients that way.

I think this is less about these products requiring a prescription and more about HIPAA and solicitation of patients.

Agree with your hesitation. I wouldn't do it if I were you.

[mlkls13]

Thank you for your reply.

I think maybe my post wasn't clear - my boss is wanting us (employees of the DME company) to get bedside RNs (myself NOT included) to propose the device to the patients to have the patients ask the physician. He is not wanting me to do it, which would be a clear HIPAA violation, he just wants us to get the nurses to do it.

My initial thought is that it would create a situation where the bedside nurse is overstepping boundaries of nursing scope, and diagnosing the patient, and suggesting treatment.

I am also thinking there must be some sort of regulations against it under the sunshine act regarding solicitation.

[JKL33]

I see. Yes, I did misunderstand; thanks for clarifying.

Well, you are wise to be cautious and think it through. Kind of a sticky position to be in.

That's kind of an interesting business idea that your boss has; I'm guessing that this is not going to be a very effective marketing attempt. I do think the bedside nurses will balk and ask their superiors to weigh in, and I don't think the hospital will see fit to do marketing for the DME employer. It may violate CMS regulations, but I've read several lengthy documents out of curiosity about your inquiry, and I can't find a specific answer. Compliance committees would not agree to this, I don't think, just on the chance that it might not "look good" even if it doesn't technically violate any CMS regs. Besides, they aren't there to do the DME company's business. I don't think they'll allow their staff to do it. [Just my thoughts].

I'm sorry for your conundrum. If you feel very strongly about getting an answer, your best bet is probably the hospital's corporate compliance people - - although I understand it would be difficult to contact them, or would take some maneuvering at the very least.

You could just leave the brochures with the discharge planners and let them know this item is available if there are any patients who may need it. The rest of it is really out of your control even if you were to ask them to do everything your boss wants you to.

Very interesting. Sorry to not be of help. I'd be interested in the answer if you are able to get one.

[amoLucia]

Agreeing along the lines of PP, JKL33, it also sounds like the nursing staff would then become "salesmen/saleswomen" for your company via the back door.

Still sounds slimy.

[Here.I.Stand, BSN, RN]

If I were in that floor nurse position, I would not involve myself in this marketing plan, no matter how aggressively you tried to "get the floor nurses to." I mean really...floor nurses don't even get a break some days and still chart after the shift is over... WHY would they add sales pitches to their list?

Plus, our PT/OTs and case mgrs are highly knowledgeable about what the pt will need after discharge -- and that's their job to arrange for the DME. I'm not about to complicate things by suggesting the pt ask for something else.

Finally, I am not qualified to determine what DME they need. I will defer to the master's/doctoral-degreed PT and OT professionals every time. I will NOT risk pt safety by making recommendations which I am not qualified to make.

[canoehead, BSN, RN]

As a staff nurse, why in the world would I help you make money if I'm not earning too?

If I did get a kick back, I'm pretty sure that would be ethically inappropriate if the Board investigated.

Then we've got possibly prescribing as a nonphysician. If the Board didn't object to that, I bet the attending physicians would.

[RestlessHeart]

The State would love to hear this scheme....not to mention Medicare and other Gov't programs

[akulahawkRN, ADN, RN, EMT-P]

To me, the way this is being suggested is very shady. Potentially bad for the company, the bedside nurse, and the OP. In short, I see this as an attempt to circumvent some rules and regulations by "suggesting" a particular product to a patient that could benefit from that product but the medical team hasn't identified that the patient could benefit from that same product, all so the patient brings that product up to the team instead of a team-member bringing that up. Shady.

That being said, I have suggested (for specific patients) that they look for a certain type of provider or type of product, but never a specific product or provider by name or anything close to that as the patient may benefit. This way the patient gets to do their own research outside of my presence to determine who they see or what may work for them. That's very different than attempting to get bedside nurses to identify patients that would qualify for a specific product in order to "drum up" business for a business that sells that specific product, especially if that business is the only vendor for that product.