rx refills

[minnesotanurse100]

I am a new grad with a first time nursing job. I see lots of different things and wonder what is legal and what isn't. First of all is it legal for a LPN to use a Dr. stamp for a rx refill. The Dr.'s note may say they need the med for chronic tx or it may say nothing about the med at all. Or does the Dr. need to be consulted everytime a refill is needed. Confused

[jmgrn65, RN]

good question sorry I don't know the answer. :)

[EricJRN, MSN, RN]

I would think that the doctor needs to be consulted. Your state BON might be the best place to clarify your specific situation though.

[flashpoint]

We are allowed to call in "maintenance meds" with out talking to the provider as long as the patient has been seen within the last year and all of their labs are up to date (TSH for Synthroid, A1C for diabetic meds, PT / INR for Coumadin, etc). We can give up to eleven refills (or enough refills to get the patient through until it will have been a year since we have seen them). If a patient needs refills and it has been more than a year since they have been in, we will usually give them enough to get them through until they can get an appointment.

We rarely write prescriptions because it is more convenient for the patient if we just call them in to their pharmacy.

[dorimar, BSN, RN]

I believe controlled substances are another story.

[minnesotanurse100]

Thanks for the reply. You say maintanence meds is this something you have prearranged with your Dr. or something that is understood?

[Johnkc8rak]

The only scripts that we write out at the office i work at are the one's going to mail away pharmacy's like Medco (With the MD ok and him signing it) . Other wise we use a service called oncalldata. It has the pt's info on it. What pharmacys they have used,what meds we have refilled (maint drugs within a year) or given them per MD order. The site checks for drug interactions also.The pharmacys (even out of state ones) can send us request's this way also. That way your not writing rx's all day or calling the pharmacy's. At the end of the day we print out a audit and the md read's what we have done and signs that he is ok with what we MA's have done.

John

[burn out]

If a patient has been discharged and the doctor forgets to write prescriptions for the patient but they are listed on the discharge instructions then we are allowed to call those meds to the patients pharmacy. If the pharmacist has a problem I fell that he can then call the doctor and get his own verbal order. I would never want to get involved with writing the prescriptions to risky for my blood.

[HeartsOpenWide, RN]

The only scripts that we write out at the office i work at are the one's going to mail away pharmacy's like Medco (With the MD ok and him signing it) . Other wise we use a service called oncalldata. It has the pt's info on it. What pharmacys they have used,what meds we have refilled (maint drugs within a year) or given them per MD order. The site checks for drug interactions also.The pharmacys (even out of state ones) can send us request's this way also. That way your not writing rx's all day or calling the pharmacy's. At the end of the day we print out a audit and the md read's what we have done and signs that he is ok with what we MA's have done.

John

This sounds like a really good system. Is it local or somthing you can purchace, I would highly recommend my office getting them. I work in the back and the front and WASTE a great deal of my patient care and time farting with RXs

[flashpoint]

Thanks for the reply. You say maintanence meds is this something you have prearranged with your Dr. or something that is understood?

For us, maintenence meds are anything that the patient takes routinely...things that are taken daily, things that are taken often (like migraine meds, Valtrex for patients with a known and frequent history of cold sores, meds for chronic pain, meds for frequent flares of gout, asthma inhalers, etc). Narcotics have to be written, but most of the time it isn't a problem unless the patient has a "narcotic contract" and even then there are rules to be followed about that and generally all the doctor does is sign the Rx because the nurses take care of the rest of it.

We're also allowed to call in certain antibiotics for certain symptoms without talking to a doctor...we have standing orders and guidelines to follow. Sometimes if there is an "outbreak" of something, we get temporary standing orders too...in February we were seeing about 20 cases of some sort of influenza a day...if people called seekign advice and were symptomatic, we could call Tamiflu in without them being seen.

We can order some labs without talking to the doctor (UA, throat culture, and anything that we need drug levels for so patients can get med refills).

Most of the clinics in this area give the nurses a lot of autonomy...once in a while we get talked to for calling in somehting we shouldn't have or for doing a lab that the provider didn't want, but it's rare...

[kelticwoman]

This last post which mentions calling in antibiotics without being assessed by a physician sounds like practicing medicine to my ear and is not within the scope of nursing.

[CritterLover, BSN, RN]

this last post which mentions calling in antibiotics without being assessed by a physician sounds like practicing medicine to my ear and is not within the scope of nursing.

though it depends on state regs, it is most likely ok as long as they are following protocols.

the narc thing another poster mentioned is also dependent on state regs.