PMHNP inpatient

[AllyW]

Hello all,

I am a PMHNP working on an inpatient adult behavioral health unit. I have a question regarding CONTINUING not initiating medical home medications. I would not be comfortable as a psych NP starting medical meds and would consult the hospitalist but any other psych nps out there that resume home medications if verified by pharmacy? Is this within our scope?

thanks!

[myoglobin, ASN, BSN, MSN]

Usually, not unless there is a psychiatric aspect to the medicine. For example I sometimes prescribe metformin to ameliorate antipsychotic induced weight gain. In some states like Arizona the board is more explicit about limiting your scope than in others such as Washington. However, in all cases it would be best practice to have a hospitalist resume the not psychiatric home medicines.  Still, in some cases (like someone taking clonidine for BP) abrupt cessation could create a life threatening hypertensive crisis and would either necessitate transferring the patient to the ER (if you could not get a hospitalist) or temporarily ordering the medication yourself (outside your scope).  

[verene, MSN]

For stable medication regimens, we can continue home medications when a patient is inpatient - provided we can confirm dose/route/reason with pharmacy.  It helps that 99% of the patients I see for admissions are being sent from another facility so I usually get a full MAR and notes to review along with the med rec form.  I'm not sure I'd be as comfortable if I didn't have clear documentation of a home-regimen.  

That being said, if I have any question or concern, for any reason, I will call up our in-house medical team and have them review and write orders for medical concerns.  

BON where I am says PMHNPs can write for medical if, and only if, we can prove we've had adequate training to do so safely and it is with in the context of continuation of care at admission/discharge/other transition of care.  Thus - I typically draw the line of if I covered it in my MSN program and/or recent CME- AND I feel comfortable in my knowledge and understanding of the medication including risks/benefits and intended action,  (I.e. would I feel comfortable justifying my prescribing decision in a court of law),  I have little concern continuing it. Everything else - I call medical to review. 

 

[AllyW]

Thanks verene! May I ask what state you are practicing in?