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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. 1 of 4 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. 2 of 4 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. 3 of 4 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 4 of 4 CAAof Columbiana County Health & Dental Centers- FOR INTERNAL USE ONLY