Jerry McCall is Dr. Williams’s office assistant. He has received professional training as both a medical assistant and an LPN. He is handling all the phone calls while the receptionist is at lunch. A patient calls and says he must have a prescription refill for Valium and that the provider, a friend, calls in the medication prior to any flights. This type of request happens often and in slightly different scenarios, but the outcome should remain the same to avoid ethical and legal issues. This paper will review the case study to help resolve the problem at hand, refilling a prescription without provider authorization.
Qualified Medical Training Understanding the definitions of a licensed practical nurse, LPN, and a medical assistant, MA is the first step to making a factual conclusion for this case study. Support staff to the provider cannot make decisions about medication refills for patients without a direct order from the provider. This action is outside the scope of practice for an LPN or MA.
Licensed Practical Nurse An LPN is a role in support of the nurse or RN, a registered Nurse usually in a skilled nursing setting such as a hospital or long-term care facility. As defined by the National Federation of Licensed Practical Nurses, NFLPN, an LPN “means the performance for compensation of authorized acts of nursing which utilize specialized knowledge and skills and which meet the health needs of people in a variety of settings under the direction of qualified health professionals” (“Nursing Practice Standards,” 2003, p. 1). Each individual state in the nation has different guidelines for the roles and duties an LPN can perform under the direction of a qualified health professional. Medical Assistant
Medical assistants typically work in different health provider’s office settings and do a combination of patient care and administrative work. According to the American Association of Medical Assistants, AAMA, “Medical assistants are the only allied health professionals specifically trained to work in ambulatory settings, such as physicians’ offices, clinics, and group practices. These multi-skilled personnel can perform administrative and clinical procedures” (“Definition of Certified Medical Assistant,” 2013, p. 1).
Case Study In the above referenced case study, the question that needs addressing is if Jerry McCall’s medical training qualifies him to refill the medication requested. Neither LPN nor MA training permits the refill of medication unless directly ordered by the provider. There are steps Jerry can take to see if the provider made advanced authorizations for this particular person. Just the verbal word of a patient is not proper authorization from the provider even if discussion with the patient during an office visit occurred. Referencing the medical record of the patient is the first step that should happen to see if the provider left a refill authorization in his office notes. The provider must list the exact name of the medication and the number of refills available if any. If this information is not available, a decision to contact the provider to gain the authorization will need to be made.
If the provider is not immediately available, depending on the type of practice and working relationship the providers have, it is possible to ask another provider to review the medical record and make a decision about the refill. The providers must have agreed to this type of decision-making within the practice before this type of request can be made of another provider. This availability between providers is a valuable resource when providers are on-call for all the patients within the practice. Documentation in the patients’ medical record of the refilled medication is necessary to allow the provider to sign off on the order and to maintain a running record of the medication history for the patient.
Difference in Medication Requested There is no difference in the actions made because of the medication requested by the patient. The provider must give the order for the medication to be refilled. There may be a very specific reason the provider did not give the patient a refill on a medication, such as an adverse reaction with another medication prescribed that may not be known to the patient and the employee.
Respondeat Superior Latin for let the master answer, Respondeat Superior is a law that makes an employer liable for the actions of an employee when the actions take place within the scope of the employees employment. This common-law puts the onus of the employee actions on the provider but does not protect the employee from other legal actions. To avoid the legal issues this can create the employee must stay within the guidelines of his or her specific licensure.
Advice Good advice in this situation is to stay true to the training earned and learned and not to work outside his or her scope of practice. Procedures are in place to protect the provider, employee, and the patient. Empathy toward the patient is necessary to explain the situation prohibiting the employee from calling in a prescription without the providers order.
Major Legal and Ethical Issues The ethical issues in this case study is practicing with the scope of practice for a licensed care professional. Because Jerry’s highest level of education is an LPN the training and scope of care he should use is at the LPN level. The NFLPN also states in their Code of Ethics, The Licensed Practical/Vocational Nurse “Shall know the scope of nursing practice authorized by the Nursing Practice Act in the state wherein employed” (“Nursing Practice Standards,” 2003, p. 1). Regulations vary from state to state, and it is the responsibility of the employee to understand the guidelines set forth by the state, and the employer regarding what is allowable authorized practice for the licensure held.
The legal issues in this case study are that without an order from a provider an LPN cannot legally prescribe or refill a medication. Prescribing medication is practicing medicine and Jerry’s licensure does not support his ability to prescribe medications. The medical board could bring a lawsuit against Jerry for malpractice. It is possible Jerry could lose his LPN license. Another legal issue could be the respondeat superior law that would put the provider in risk of a lawsuit.
Problem-Solving Methods This is a common sense problem to solve. Although empathy for the patients’ situation and the requested medication may cause some second thoughts, the repercussions outweigh the empathy Jerry may have toward the patients situation. The loss of employment and licensure are not worth the return problems Jerry will have to face. Following the office procedures set in place to get the medication refilled through another provider or trying to reach the patients’ provider to obtain an order are the right steps to help the patient with the medication refill request.
Conclusion In conclusion, the bottom line is to practice within the licensure he or she has. Physicians, Nurse Practitioners, and Physicians Assistants can write prescriptions or authorize prescription refills. Nurses, licensed practical nurses, and medical assistants must obtain authorization from the provider prior to refilling medications. Prescribing medications outside his or her scope of practice has ethical and legal ramifications. This action could result in lawsuits against the provider as well as the employee who illegally refilled a prescription. Common sense problem solving should be used to resolve the refill authorization, such as getting a onetime refill authorization from another practice provider or calling the provider directly to get a verbal order. Following the established procedures will help avoid any adverse reactions for the patient and unwanted legal actions for the provider and employee.