Download CS 40 Standing Authority for RN - Ohio Association of Community

CS-240
Issue Date: 02/25/2011
Effective Date: 02/25/2011
Last Review or Revision Date: 08/07/2012
Policy Name:
Originating Department
Standing Authority for RNs
Laws, Regulations or Standards Associated With This Policy:
Related Policies:
Related Attachments:
Board approved 2-25-11
Policy Type:
 New
 Revision
 Replacement (specify):
POLICY:
It is the policy of the CAA health centers to employ licensed, qualified personnel to use
independent judgment regarding patient prescription refills within the scope of the centers’
policies.
PURPOSE:
This policy will create an environment that encourages licensed clinical staff to use their
training, background and knowledge to care for patients in a way that improves the flow and
function of the clinical setting in order to improve patient care and effectively manage staff,
provider and patient time.
PROCEDURE:
According to their training and licensure, registered nurses will facilitate calling patient
prescription refills to the pharmacy in the following manner:
1. Front desk and other clerical and/or support staff will route patient requests for
prescription refills to the registered nursing (RN) staff. If the front desk/clerical/support
staff is unsure of how to handle a message, they will immediately seek the advice of the
site supervisor or charge nurse.
2. LPNs will not phone in a prescription unless the provider has approved the prescription
and instructs the LPN to call it in.
3. RNs will verify the exact name of the medication, including trade name and/or generic
name as applicable. Verification includes correct spelling of the medication.
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CAAof Columbiana County Health & Dental Centers- FOR INTERNAL USE ONLY
CS-240
Issue Date: 02/25/2011
Effective Date: 02/25/2011
Last Review or Revision Date: 08/07/2012
4. RNs will handle only the prescription requests that are familiar to the RN. This includes
an understanding of the medical problem that this medication is commonly used to treat.
RN will verify via the patient record the reason this medication is being used by this
patient.
5. RNs will verify the correct dosage of the prescription in question.
6. RNs will verify potential patient allergies and/or medication interactions before calling
the script to the pharmacy.
7. Prescriptions that are included in this policy’s guidelines include:
A. Routine maintenance medications used for reflux/hiatal hernia, such as ranitidine,
nexium, omeprazole, prilosec.
B. Routine medications used for allergies, seasonal or environmental such as claritan,
loratidine, zyrtec.
C. Routine blood pressure medications such as lisinopril, metoprolol, HCTZ.
D. Routine diabetes medications such as metformin, glyburide, actos, insulin.
E. Routine asthma medications such as advair, albuterol, pro-air, albuterol solution for
home nebulizer.
F. Routine antidepressants such as prozac, celexa, wellbutrin, paxil.
G. Routine medications for hyperlipidemia such as lovastatin, lipitor, pravastatin.
H. Routine medications for chronic medical conditions. This will be limited to medical
conditions that have been treated by health center providers for six consecutive
months or more, such as gout, seizure disorders, etc.
8. Prescriptions that do not fall under these guidelines include:
A. Coumadin. This is never to be refilled without the written consent of the provider.
B. Any and all narcotic analgesics such as vicodin, percocet, percodan, tylenol #3 or #4,
darvocet, darvon, talwin, tramadol.
C. All anxyolitics such as xanax, lorazepam, clonazepam, valium
D. All hypnotics such as ambien, restoril.
E. All nsaids such as motrin, diclofenac, naproxyn.
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CAAof Columbiana County Health & Dental Centers- FOR INTERNAL USE ONLY
CS-240
Issue Date: 02/25/2011
Effective Date: 02/25/2011
Last Review or Revision Date: 08/07/2012
F. Psychiatric medications such as lithium, lamictal, aricept, seroquel, resperidal.
9. Any medication about which the RN is unsure or that the RN questions in any way must
be brought to the attention of the charge nurse or site supervisor to secure the written
order of the treating provider. There are no exceptions to this. it is the nurses’
responsibility to have all questions answered before calling any refills to the pharmacy. if
in doubt, the RN is to obtain the provider’s written order.
10. The number of pills and/or refills is determined by the schedule of visits, the reliability of
the patient, the number of cancellations/missed appointments, the need for an
appointment, and the previous direction of the provider. Guidelines for these are as
follows:
A. No person is to receive more than a three month supply
B. Patient in one of our collaborative studies (diabetes or cardiovascular) are to receive
only the correct amount of pills/refills until their next scheduled appointment.
C. If a patient is over-due for an appointment, the RN will call in only enough
medication until their next scheduled appointment and in no case will this ever
exceed a 30 day supply.
D. If a patient chronically misses or cancels appointments, they are not to receive any
refills unless approved by the charge nurse/site supervisor and/or the provider. This is
for any patient that has two or more broken (cancelled, no-show) appointments in a
row or who have not been seen by a health center provider for more than three
months.
E. If a patient is deemed unreliable, unsafe or irresponsible by the RN, the charge
nurse/site supervisor or the provider, no more than a 30 day supply of medications is
to be called in without a scheduled follow up appointment unless the RN obtains the
written order of the provider.
F. If a provider decides or states it is acceptable to refill a medication that does not meet
this policy’s guidelines, it is the responsibility of the RN to document the provider
instructions and bring this documentation to the attention of the charge nurse or site
supervisor.
11. Once a prescription refill is called in, the chart must be given to the provider to be cosigned. The RN will clearly mark the chart so that the provider knows that the chart is a
prescription refill co-sign order must be approved by a Provider. All refill charts orders
must be co-signed within 24 hours 2 business days. If the Provider is not available, the
refill must will be given to the charge nurse or site supervisor, who will decide which
available provider is appropriate for the co-signing.
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CAAof Columbiana County Health & Dental Centers- FOR INTERNAL USE ONLY
CS-240
Issue Date: 02/25/2011
Effective Date: 02/25/2011
Last Review or Revision Date: 08/07/2012
Exception Process: There are no exceptions.
Monitoring:
Will be at the discretion of the Quality Committee.
Signature:
Beth Weir, COO
Name
Date:
Chief Operating Officer
Signature:
David Cola, D.O.
Name
Date:
Medical Director
Signature:
Sandy Gruszecki, RN
Name
Date:
Charge Nurse
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