Signing "Proxy" orders for refills

[frenchy]

I am a new PA in my first job.  I work outpatient internal medicine (Primary Care really.)  There are 3 providers in the office, including myself.  One physician and one other PA.  Of course we are all proxies for each other to cover during absences.  So the clinical staff will get requests for medication refills from patients and if the patient requesting a refills PCP is out the staff will propose the order to a different provider to sign.  My question is, how deep do you dig before signing these orders?  If it is for omeprazole, is it just "OK and next?"   Certainly for controlled meds I would do the required Istop, etc. and hesitant still then.  What else would make you hesitant to refill for another provider?  ASKING FOR A FRIEND OF COURSE......   

[dchampigny]

I think it varies based on the medicines.

 

Our clinical staff are trained to do all of the above research before sending a request to us such as seeing when patient was last in the office, when next appt is, are they filling it routinely etc.

 

For regular medicines, I am fairly lenient. I will look in the chart to double check that the patient has been coming in regularly. An extension of this is making sure they have an upcoming appt. A lot of times it is an education thing. Sometimes I will get a refill for like 90 tablets of lisinopril with 5 fills and I educate the staff to make sure patient has a lab slip and an upcoming appt. I see it as an opportunity to help them learn about hyperkalemia, etc. But usually I will go in and change it to say, patient will get 30 tablets with 1 refill and would recommend they get a BMP drawn. 

 

Patients should know via their contracts that any refill can take 48 hrs to process. For example, with controls, our clinical staff know to look up in the data base when the fill was and talk to the provider personally if there are any "red flags". If there's any doubt, the prescription can wait a day or two to be filled. Patients should be accountable about not calling the day they run out of their med.