Prescription writing is one of the most important tools of the trade that you must grasp as an APRN. Not only does prescription writing put you at risk with your professional license, but more importantly, this skill directly impacts the safety of your patients. Medication or communication errors will land you in hot water. Did you know that medication errors make up 17% of Nurse Practitioner claims?
1. No matter how many times they may ask you, do not write a prescription for yourself or your family members! Although this may sound like common sense, it is a surefire way to land yourself in trouble, either with your state nursing board or the drug enforcement administration. Furthermore, there needs to proper documentation of the clients visit, including the plan and any follow-up appointments in the client’s medical record.
2. In addition to reviewing your patient’s known allergies, always consider whether your patient may by pregnant or is breastfeeding. As a PMHNP you may find yourself managing patients on medications such as Lithium, Valproate, Paroxetine, or Carbamazepine. Not only does a woman’s volume of distribution change during pregnancy, which can alter a drug’s pharmacokinetics, but these medications may pose serious risk to the fetus.
3. Do not pre-sign a prescription pad. When using a pad that has other clinicians of the same group listed on the script, make sure to circle your name for proper clarification.
4. Know your formulations, dosage strengths, etc. (Eopcrates or up-to-date are great resources). Eopcrates will assist you with prescribing and help keep you within the standards of care. For Example; Bupropion SR vs. Bupropion XL. Are you prescribing the drug once a day or twice a day? (SR vs. XL).
5. Familiarize yourself with your state laws and stay within your scope of practice in regards to prescription writing and autonomy.
6. Make it a habit to include the medication indications and the rationale when writing for “PRN” medications.
7. Be aware of the Joint Commission’s do not use list. Always spell the name of the medication out, in its entirety, and avoid using abbreviations (MSO4, APAP, etc.). Commit that list to memory, avoid using Latin and your prescription writing skill will improve immensely.
8. Be sure to review your clients current list of medications to avoid any drug-drug interactions. Polypharmacy is a widespread problem, especially for older patients with multiple medical comorbidities who see more than one provider.
9. Be explicit! “Take as directed” adds no value to a prescription and should be avoided.
10. A properly written prescription should include the client’s name, date of birth, medication and dosage, route to be administered, quantity to dispense, number of refills and signature of the APRN
** Finally, avoid co-prescribing benzodiazepines w/ opioids whenever possible. Need a refresher on how to write a script? Click on the video below to learn how to write a script in under 60 seconds.
What would you add to this list?