Nurse/MA medication refill protocols

[camoman1234]

Could anyone help me out with setting a nurse/MA medication refill protocol in my clinic. I have looked all over the web and have not found anything I really like. I would like a table format, but after working on it several hours I am not sure if that will work. Any advise, documents, suggestions, etc would be greatly appreciated!  

[KMD16]

Under no circumstances will I allow my nurse or MA such privilege. This's bad practice! And could result to many headache. Just simply refill your medication.

 

Those who haven't follow up and has had multiple no show to their appointment; I often time will not provide refill until I see them again in the office. Will warm them first.

 

IMHO.

[jmj11]

They can certainly do all the leg work, look for past refills, and etc. But never approve a refill. That is the same as prescribing and no MA or nurse has prescription privileges and can not be delegated those privileges.

[beattie228]

I had a MA/Nurse protocol in place at my last position that any prescription request sent to me had the template:

 

(Patient name) is requesting (drug name/dose/sig). Last prescribed (date). Last seen in office on (date) by (provider) with instructions to follow up in (time frame).

 

From there I would give yes/no responses and instructions to f/u if needed to be seen. Under no circumstance should a med be refilled without clinician oversight but it can be a time saver for them to do the chart review. 

[camoman1234]

I left the corporate world about 1 1/2 years ago and run a private practice. Over the last several years in corporate medicine, every clinic had a MA/nurse medication refill protocol. I have never worked anywhere that did not have such a policy. I kindly disagree with the MA/Nurse practicing medicine because that would mean that paramedics and respiratory therapist would be practicing medicine with their medic/physician or therapist/physician driven protocols. I have worked with paramedics respiratory therapist in the past in the ED that gave medications, changed vent/bipap settings, started a patient on q6 albuterol nebulizers with their therapist/physician driven protocol. Also, look at ICU RN's and their protocols. Again, thanks for the comments/concerns, but I am looking for other PAs that have protocols in place. Lastly, the reason I would like such policy in my current practice is we still paper chart and the staff has to pull the chart, go through the chart, write up the medication, carry the charts about 150 feet to place on my desk then I have to approve them and carry them all back. Terrible hassle and I can not go to EHR unless I buy out the practice, the owner will not change.  

[Reality Check 2]

We had protocols for conditions and how long they could receive refills.

 

The ideal was that the patient was seen on X date and refills were placed for 3-6-9-12 months based on medical condition and follow up.

 

We had charts that said HTN, 6 months; DM, 3 months, thyroid, 6 months, etc etc.

 

The patient had to have physically been seen in the office for that condition within one year to even be remotely considered for refill.

 

The nurse/MA could receive the request, look in the chart for last date seen and labs --- and then consult the grid and say the med could be refilled for 30 days while patient got labs and made a f/u appt. OR for appropriate interval. 

 

We never filled controls by chart or grid. Those were all personal eyeballs on and sign by provider.

 

My grid listed HTN, hypothyroid, DM, CHF, asthma, birth control and other titles for common conditions.

 

The condition with the least interval always wins - so DM is Q 3 months - period. 

 

We had multiple providers and some tried to micromanage the grid but we came to a common consensus so that the nurses didn't have to schizophrenic to function.

 

My office is so small now that my MA just looks over and asks or sends me a task to respond to. No grid needed.

 

Hope that helps.

[camoman1234]

RC2: Thanks for the reply. That helps, but I HATE being "looked at and asked", that is why I moved in the back to get away from all the noise/being interrupted on those issues. I like to do things on my time and not having to multitask with patient care and medication refills. The patients in the office always come first then patient phone calls then medication refills. I am the lone ranger in the clinic with 4 full time ladies helping me run this show, so I rely on them more than they rely on me. Would you happen to have a template of the grid you used?

[rev ronin]

[...] I HATE being "looked at and asked", that is why I moved in the back to get away from all the noise/being interrupted on those issues. I like to do things on my time and not having to multitask with patient care and medication refills.

Consider doing refills all at once per day: All at lunchtime, all after clinic hours, all before the first patient.  Anything else can wait until the next day's time, or can go to the ER... :-)

[camoman1234]

Rev: Thanks for the reply. Those are all great suggestions. I am going to sound like a whine bag, but here we go. I try not to do work over lunch (key word try), I am ALWAYS late to work (I am lazy and sleep in :) and my wife yells all the time at me for this, haha), and I do not want to stay late doing Rx refills. So, basically I like the system of protocols I came from where the MAs/LPNs did all this via a protocol. On a serious note, how does this type of protocol differ from any medic/RT protocol? I can't seem to see the difference and would really like others input.  

[UGoLong]

We have staff refill cardiac meds (our specialty) only, and only enough to get them to an appointment with us in the next few weeks.

 

 

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[sas5814]

I was in a RHC for 12 years. each provider had their own nurse (so this may not work for you) and we each had our own preferences for refills handled by the nurse or MA. I just don't know any other reasonable way to do it. I had my preferences and comfort level with my nurse...others had theirs. Generally ongoing meds like BP meds, diabetic meds, seizure meds could be refilled for a brief period (say a week) to keep the patient from running out with the understanding they had to be seen before they got any refills. Never refill anything scheduled. never refill antibiotics. Never refill antiinflammatory or spasm meds.

After 1 refill per above if they called for another it had to be brought to to the provider. The nurse or MA couldn't just say no because it was protocol.

Not specific but I hope it is closer to giving you some ideas.

[camoman1234]

Thanks for the reply sas5814. I have been in this RHC for ~1 1/2 years which I plan on buying out. I agree on the nurse/MA never refilling ANY scheduled medications, ABX, muscle relaxers, antiinflammatory, as well as steroids of any kind (oral/topical). 

[jb5158]

I had a MA/Nurse protocol in place at my last position that any prescription request sent to me had the template:

 

(Patient name) is requesting (drug name/dose/sig). Last prescribed (date). Last seen in office on (date) by (provider) with instructions to follow up in (time frame).

 

From there I would give yes/no responses and instructions to f/u if needed to be seen. Under no circumstance should a med be refilled without clinician oversight but it can be a time saver for them to do the chart review. 

 

This is almost exactly what we do. The refill request gets sent to the nurses through Epic. They go through chart and make sure the dose is correct. They put in the # of refills they think we will want (typically just enough to get to the next visit). They also list when the last appointment was and when the next one is. They then forward it to the PA or doc and all we have to do is review, make sure it's appropriate and click sign. The only time the nurses EVER "prescribe" medication is if we give a verbal order. With this, I can get through several refill requests in minutes.