You are a Family Nurse Practitioner employed in a
busy primary care office. The providers in the group include one physician and
three nurse practitioners. The back office staff includes eight medical
assistants who assist with patient care as well as filing, answering calls from
patients, processing laboratory results and taking prescription renewal
requests from patients and pharmacies. Stephanie, a medical assistant, has
worked in the practice for 10 years and is very proficient at her job. She
knows almost every patient in the practice, and has an excellent rapport with
all of the providers.
Mrs. Smith was seen today in the office for an
annual physical. Her last appointment was a year ago for the same reason.
During this visit, Mrs. Smith brought an empty bottle of Amoxicillin with her
and asked if she could have a refill. You noted the patient’s name on the label
and the date on the bottle was one week ago. You also noted your name printed
on the label as the prescriber. The patient admitted that she called last week
concerned about her cough and spoke to Stephanie. You do not recall having
discussed this patient with Stephanie, nor do the other providers in the
What is your next logically sound course of action? Provide evidence to support
Upon further investigation, you learn that Stephanie
spoke with the patient and called the medication into the patient’s pharmacy
without consulting with a provider. Stephanie claimed that the patient was
insistent about needing a prescription. Since Mrs. Smith was coming into the
office the following week for an appointment, she didn’t think you would mind
if the patient received the prescription early.
What are the ethical-legal concerns associated with this situation? Provide
evidence to support your response.
Due to the incident, you are concerned with office
policies and procedure. Upon investigation, you find there isn’t a policy in
place to address non-urgent patient requests for prescriptions.
What quality improvement strategies might you implement as an APN in this
practice to safeguard your role and assure patient safety? Provide evidence to
support your response.