This week's Risk E-Notes will address the following question posed to the CAP Hotline:
Q: May our office staff or medical assistants approve e-prescribed refill requests from a pharmacy?
A: To answer this question, we will review what the Medical Board of California (MBC) advises on its website. The MBC provides the following question and answer: Can medical assistants call in refills to a pharmacy?
Yes. Under the direct supervision of the physician or podiatrist, a medical assistant may call in routine refills that are exact and have no changes in the dosage levels. The refill must be documented in the patient's chart as a standing order, patient specific. Medical assistants may not call in new prescriptions or any prescriptions that have changes. The physician should view carefully his or her decision to allow medical assistants to perform this task, as the authority to prescribe or refill prescriptions is only granted to licensed physicians and surgeons, podiatrists, or those individuals authorized by law to do so.
These same recommendations should be applied to e-prescribing refills.
CAP recommends that offices have guidelines in place related to all medication refill requests. The best practice is to allow only the physician or other licensed prescriber, such as a nurse practitioner or physician assistant, to approve both written and electronic refills.
However, if a physician decides to give authority to staff to approve written or electronic refills, written guidelines should be developed which may be either patient-specific or medication-specific. They should include the name of the medication and the number of refills permitted before a follow-up appointment is necessary. There should also be documentation of refill date, medication, dosage, and the staff member who approved the refill.
Authored by
Ann Whitehead, RN, JD
Senior Risk Management & Patient Safety Specialist
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.