Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Week 1: Discussion- Foundation of the Role of the Nurse Practitioner as Prescriber Legal and Professional Issues in Prescribing24 24 unread replies. 90 90 replies. Describe NP practice in your state.Tell the class what your state laws are related to nurse practitioner prescribing.Include how many continuing education hours are required for your state.Describe the importance of knowing the specific laws in your state pertaining to Nurse Practitioners prescribing medications.Search entries or author Filter replies by unread Unread Collapse replies Expand replies Subscribe Subscribed Reply Reply to Main Discussion Collapse Subdiscussion Shelley ClarkeShelley Clarke Apr 30, 2018 Apr 30 at 9:21am
Week 1 Initial NR 508 Dr. Hall and Class, The American Association of Nurse Practitioners [AANP, What’s an NP] (2018), outline the services that nurse practitioners (NP) provide to include autonomous and collaborative provisions of primary and acute care services. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing. Specifically, the NP mayorder, perform, and translate diagnostic studies, diagnose and manage acute and chronic illnesses, prescribe medicinal and other therapeutic regimens, manage general care, and counsel and educate patients on disease prevention and wellness promotion (AANP, What's an NP?, 2018). In the state of Florida, nurse practitioners (NP) are regulated by the Board of Nursing and Board of Medicine (AANP, 2018). Additionally, NPs function under a restricted practice (AANP, 2018). It is the most limiting regulation for NPs. Restricted practice means that the NP may not engage in some compnents of their scope without direction or delegation from another healthcare provider for life of their career (AANP, 2018). Such limitation prevents the NP from performing to their fullest potential for their education and training received. Prescriptive authority for the NP varies from state to state. In the state of Florida, NP prescriptive authority is defined in Florida statute 464.012 which states that the NP may prescribe scheduled II through IV drugs under a supervisory agreement with a physician (TheFlorida Legislature, 2018) Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing. Specifically, the authority to prescribe and dispense scheduled II drugs wasrecently granted to the NP as of January 1, 2017 (FBON, 2016). Scheduled II drugs are controlled substances such as opioid analgesics that have high potential for addiction and abuse (DEA, n.d). Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing. NPsmust remain abreast of the changes in evidence-based practice and medicine in order to practice competently and safely. According to the Florida Board of Nursing [FBON] (2018), NPs are required tocomplete 24 hours of continuing education for renewal of licensure every two years, and 26 hours every third renewal with the inclusion of 2 hours of domestic violence. NPs practicing in specialized areas should also include continuing education in these areas. Alleman (2013) posits that while specialty certification is not mandatory for areas such as nephrology, it is a means for indicating that certain standards of practice have been aquired to pactice safely in a specialized area. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

FNPs and other providers who have the legal authority to prescribe must follow ethical guidelines to ensure patients are safeguarded from harm. Responsibility starts with providers being educated about the new medications and specialty drugs on the market, according to Alison Mitchell, MSN, and Catherine M. Oliphant, PharmD, in “Responsibility for Ethical Prescribing.” Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

“The responsibility of conducting a comprehensive patient interview and obtaining a complete medication list [is] just the beginning of the critical analysis of possible interactions and side effects,” Mitchell and Oliphant said in a guest editorial in CrossMark. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

For FNPs and other providers, the responsibility of prescriptive authority is more than just simply writing a prescription correctly. Providers must understand drug interactions and possible side effects. Advanced practice registered nurses (APRNs) who are seeking a post-master’s FNP online certificate must be able to apply their knowledge of pharmacological agents to individuals through the stages of their life, especially for patients who are taking multiple medications. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Considerations in Ethical Prescribing

Studies show nearly one-third of adults in the United States takes five or more medications daily. The more medications a person takes, the greater the chance of adverse drug events, the U.S. Department of Health and Human Services said.

The World Health Organization suggests a multi-step approach to prescribing that may help providers better focus the intent for the treatment. The guidelines were established in 2007 and are still applicable today. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

  1. Evaluate and define the patient’s problem.
  2. Determine the therapeutic objective of the drug therapy.
  3. Select an appropriate medication.
  4. Provide patients with information, warnings and instructions.
  5. Monitor the patient regularly.
  6. Consider drug costs when prescribing.
  7. Use appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors.

A major component of ethical prescribing is an examination of each patient’s distinct needs and situation. For clinicians, many ethical challenges from the past decades are still present today. Some of them include:

Prescribing to family and friends

Healthcare attorney Carolyn Buppert, MSN, said while some practitioners prescribe for family and friends, the practice is “generally not a good idea.” Laws and regulations differ by state — some states expressly forbid providers from prescribing medications to family and friends, while others simply advise against it. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

“There is an ethical problem in that the close relationship could cloud the practitioner’s judgment,” Buppert said in the Legal and Professional Issues for Nurses section of Medscape Nurse.

Depending on the state, FNPs could face legal implications for prescribing to family and friends. If a state requires FNPs to have a collaborative relationship with a physician to practice and prescribe, that authority is limited to the practice setting. Writing a prescription for a friend in a social setting could trigger legal action.

In a state where FNPs can independently practice and prescribe, the major complication would focus on what is best for the patient and whether local boards of ethics have opinions on the matter. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing. Defense is usually difficult, Buppert said.

Prescribing animal-derived medications

Animal-derived ingredients such as lactose and gelatin are commonly used in prescription drugs. Extensive animal testing is often used before a prescription medication is put on the market. Patients who are vegetarians or vegans, or who have other dietary restrictions, need to know about the animal ingredients and testing to make an informed decision about treatment. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

While patients are responsible for telling medical professionals about their beliefs and lifestyle choices, clinicians also should provide information that allows patients to make informed decisions.

“If this topic is not discussed, patients discovering that their medication contains animal products may stop taking it, with potentially life-threatening consequences,” practitioners said in “Ethical and Practical Considerations in Prescribing Animal-Derived Medication” published in BMJ.

Managing prescription errors

When faced with the choice between disclosing a prescription error and not disclosing, clinicians should always choose the former. In any nursing scenario, medication safety is vital. If a problem does occur, FNPs should be forthcoming, said Randi Tollison, MSN, in an article titled, “The Ethics and Legalities of Medication Error Disclosure.”

Tollison said FNPs should explain to the patient how the error happened, explain how the harmful effects of the error will be ameliorated and provide steps that will be taken to ensure the error does not happen again. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Tollison said to prevent future errors, clinicians should ask themselves several questions before prescribing any medication:

  • Is this drug needed to treat the presenting problem?
  • Is this the best drug for the problem?
  • Are there any contraindications to this drug with this patient?
  • Is the dosage correct?
  • Does the patient have allergies or sensitivities to the drug?
  • What drug treatment does the patient currently use, and will the potential new drug interact with the patient’s other drugs or treatments?
  • Is there a problem with storage of the drug?
  • Does the dosage regimen interfere with the patient’s lifestyle?
  • Is the route of administration the most appropriate one?
  • Is the proposed duration of treatment too short or too long? Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Prescribing pain medication

In states where FNPs have prescriptive authority, many are also legally authorized to prescribe controlled substances, including opioid painkillers.

Opioids were once a cornerstone for treating chronic and disabling pain. Now, they have driven a drug-addiction epidemic that claims the lives of 115 people in the United States every day. In many cases, the use of opioids leads to the use of heroin, fentanyl and other narcotics.

State and federal agencies are trying to rein in opioid use by setting limits on prescriptions. Clinicians are being urged to prescribe with caution. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

The Nurse Practitioner Healthcare Foundation said clinical chronic care pain management requires four elements:

  1. A comprehensive assessment of the pain and past efforts to treat pain
  2. An examination of a wide range of treatment options besides opioids
  3. Ongoing patient education about the associated risks
  4. Vigilant follow up to mitigate possible substance abuse

FNP Nursing and Medication Safety

Medical professionals from the Nurse Practitioner Healthcare Foundation also said FNPs are in a position to align practice, policy and research to optimize pain treatments while minimizing the risk for opioid abuse.

“NPs on the front line of care delivery are well positioned to bring forward these messages because we will not gain if good practice outcomes are not guided by policy and we will not gain if good practice outcomes do not guide policy,” practitioners said in “Pain and Opioids: Call for Policy Action.” Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing

Indeed, APRNs who pursue a post-master’s FNP online take coursework in pharmacology to better understand the effects of pharmacological agents on people through their lifespan. FNP students also study potential drug interactions and the use of clinical judgment. Discussion- Foundation of the Role of the Nurse Practitioner as Prescribe Legal and Professional Issues in Prescribing