Cwheeler Posted January 12, 2016 Share Posted January 12, 2016 My current ED group staffs a free standing facility and in the near future they have told us that during certain hours (2-8 or 9) when no hospitality is present we will be covering codes in the inpatient side and asked to leave the ED for such. I have more than a few concerns about this and wanted some opinions First, there will be no direct supervision for this, is that outside my scope of practice then? During these hours the position will be paid 50/50 by my group and the hospitalist service (None of which I have a supervision agreement with currently) who is my supervising physician on the floor? Second, who orders the RSI drugs, that is not in my state formulary. I know that we can order ACLS drugs but what happens in the post recessive effort if lucky enough to get patient back, my state formulary does not allow us to start drips without physician initiation either Has anyone been asked something similar of their employer? Any other concerns that I could bring to my attendings before this goes to far? Link to comment Share on other sites More sharing options...
ONE40pt6 Posted January 12, 2016 Share Posted January 12, 2016 I'm curious about the forthcoming answers. What state are you asking about? Link to comment Share on other sites More sharing options...
Cwheeler Posted January 12, 2016 Author Share Posted January 12, 2016 Ohio Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted January 12, 2016 Administrator Share Posted January 12, 2016 Ohio Move? :-) Seriously, I have no clue, but that sounds so lame to have those not orderable by PAs. Can you get standing physician orders written to cover such an eventuality? Link to comment Share on other sites More sharing options...
bike mike Posted January 12, 2016 Share Posted January 12, 2016 That is insane....you can't order drips? So the person you just got back from VT arrest will have to wait to get an Amio gtt until a physician arrives? In my hospital it is often the PA's running the code and we order whatever we need. Link to comment Share on other sites More sharing options...
Cwheeler Posted January 13, 2016 Author Share Posted January 13, 2016 Here is a link to our formulary http://med.ohio.gov/DNN/PDF-FOLDERS/Prescriber-Resources-Page/Physician-Assistant-Prescribing/Physician-Assistant-Formulary.pdf Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted January 13, 2016 Moderator Share Posted January 13, 2016 I agree with move. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 13, 2016 Moderator Share Posted January 13, 2016 yup. no restrictions at my rural jobs in WA. scope is same for doc and PA. move. Link to comment Share on other sites More sharing options...
coloradopa Posted January 13, 2016 Share Posted January 13, 2016 My current ED group staffs a free standing facility and in the near future they have told us that during certain hours (2-8 or 9) when no hospitality is present we will be covering codes in the inpatient side and asked to leave the ED for such. I have more than a few concerns about this and wanted some opinions First, there will be no direct supervision for this, is that outside my scope of practice then? During these hours the position will be paid 50/50 by my group and the hospitalist service (None of which I have a supervision agreement with currently) who is my supervising physician on the floor? Second, who orders the RSI drugs, that is not in my state formulary. I know that we can order ACLS drugs but what happens in the post recessive effort if lucky enough to get patient back, my state formulary does not allow us to start drips without physician initiation either Has anyone been asked something similar of their employer? Any other concerns that I could bring to my attendings before this goes to far? I would contact OAPA but a quick perusal of the OAPA site finds this: The restrictions on prescriptive authority in ORC Section 4730.411, division (A) of this section (terminal patients) do not apply if a physician assistant issues the prescription to the patient from any of the following locations: Basically if you work for a hospital or physician group (as I understand it) the restrictions don't apply. We have a similar problem in GA. We can't prescribe schedule IIs but we can order them for inpatients under delegated authority. Presumably this is what other PAs that work on the inpatient side use. Link to comment Share on other sites More sharing options...
Evolute Posted January 13, 2016 Share Posted January 13, 2016 No drips, no rsi... wtf!? Before I would even consider doing this that would have to be changed (or at least clairified, see coloradopa's post) I work in rural MT and my scope is equal to the docs with no restrictions. Anyway, one of the first questions I would ask is. If I can't order drips, rsi, etc, who will be there to order them for me? Specifically which doc is going to be there (on site)to order said intervention? I suspect they will respond with open mouths and dumb looks. And most likely say something like "we didn't think about that". Next, you need to know who your collaborating physician is when covering codes for the inpt side. Is it your ED doc? the hospitalist? This needs to be decided before you start covering the inpt side. If you can't get those (and all other questions/concerns you have answered) before hand I would not agree to to it. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 13, 2016 Moderator Share Posted January 13, 2016 at one of my rural jobs I am the only clinician in the hospital at night. there is an fp hospitalist during the day, but if it hits the fan at night it's me. I'm covered because I am a hospital employee and can even admit obs pts under my own name for up to 24 hrs. Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.