Home Forums Discussions Problems Escribing

We have a question regarding the Amazing Charts electronic Rx; is there a way that the nurse at the office can write the prescriptions and forward them to the Dr for review and sign.Up until now we have been using allscripts which the nurse was able to prepare the scripts with that program.

With the latest version of Amazing Charts, you can authorize nurses to "write" prescriptions but I don't think they can be forwarded for review & signature.

No offense but it's fairly easy for the provider to write prescriptions using amazing charts. All the provider needs to know is the patients preferred pharmacy as it doesn't always get saved in the chart.

The nurse could always be the one who enters the medications the patient is taking into their medication list including dosage, frequency etc. Then all the provider would have to do is click on the med in the script writer and send to the appropriate pharmacy.

My MA's do this all for me.

I think we think way too little of our MAs. If my MA had to write the script, then send it to me for approval, I may as well do it myself.

My nurse does three things:

1. Refills
2. Scripts that I asked for after getting a message
3. Scripts that she knows I would write for

Sometimes we are extremely busy, and someone calls in with pinkeye. She would generally ePrescribe Vigamox and possibly have them come in the next day. Any time she does that, she uses the process of using the med writer next to the message. This puts the exact script in the message. She highlights it red and sends it to me. Given I see a pt every 15 to 20 minutes, I open the message, agree with it and save it to the chart. If I don't agree with it, I send it back. Perfect medicine? Probably not. If Medicaid paid what it should, I wouldn't have to. It is just way more efficient. Been doing it this way for over four years.

My staff can go onto a computer onto which I am logged on, write a script (refill) and send it where it needs to go. This happens a lot after I have already seen the patient and leave the room. They get to the front desk and say "oh, I need her to refill my mail order scripts". The staff takes care of it then and there, the patient is happy, I am happy and the MA is thinking to herself, "stupid idiot, why didn't you tell her when you were in the room with her?"

So Bert, you are letting an MA write refill scripts and send them to pharmacies without getting an approval first? While they may be able to do this, you are responsible for any mistakes. I don't feel I can take this risk. It is so easy to hit the refill and so quick, I don't know if I could ever turn that over to an MA.

I can. Even write scripts for diaper rash, etc.

And, I do approve it. Only an hour or so after the fact.

I do the same thing as Bert.
It has to do in part with staff you can trust, and in part with protocols that you set in place.

For example, Bert's practice of peds is well suited to allow staff to prescribe meds for diaper rash and conjunctivitis. He does this under his supervision, which makes it legal, and he has a protocol in place that under a specific situation his staff will react with a specific reaction.

Another example, my office (FP) is suited well for standing protocols on refills for diabetic meds, anti-hypertensives, diuretics, and the like. In our case, my staff will refill these chronic meds for 90 days with 1 year of refills. Provided the patient has been seen within certain time frame, they get refilled by staff. The well controlled HTN pt needs at least once yearly visit for me to renew meds. The diabetic pt needs every 3 month visits for me to renew meds. The staff knows these different circumstances and refill under my authority.

Our state law does not require that I be the one to personally write the Rx.

This may boil down to your level of comfort. But as a solo FP/sole-proprietorship, it's not possible for me to see all the patients, make all the money, make all the business decisions, fix all the computer issues, AND refill all the meds personally.

Is your MA is logging under your account to write the script? Reason I am asking is because , my thinking is the person need to have Lic/DEA etc to transmit the script.

.

Okay, so you DO always know what is going on because she is immediately sending it over to you. Probably safer with things like diaper rashes than atrial fib! It sounds like you have good staff.

I do have a great staff. My MA is unbelievable. She literally is only two steps below a NP. Of course, that could be dangerous.

I just don't understand why everyone doesn't get it. This is one of the perks of v6 (or was it v5?)

First, no staff logs in under anyone else's AC and does anything other than find a chart. Messages need to be documented by who sent them. Logs have to document who did what?

When you set up a user, you can make them capable of sending scripts. You can allow your dog or the GEICO Gecko to send scripts.

My MA's send ERx's under their own profile. Their profiles are linked to my name/prescribing information, as depicted by Bert's pics above.

Bert,
The problem with the way you set up your MAs is that, if you make them medium level users, the Eprescribe box can be set but they cannot import items without sending them to me first for another signature (I sign them in Paperport). If you set them as High-level users, they can import without a signature but the eprescribe option is greyed out.

I do this and have to sign off all the import items. I didn't know there was a way not to have to sign all those imports.

Leslie, Obviously you aren't using the Gecko.

Prior to v6, my workaround was to make those who needed to ePrescribe high-level users. (Providers). Worked great until New Crop and AC didn't like it. After all it was another provider or two or three.

Well, one would think you would not have to pay another provider fee for a rotating intern who would be a high level provider. IMO, the number of providers billed should be based on the number of users who have DEA numbers and state licenses.

Our issue is that we have 3 nurses and 3 docs - all 3 nurses write Rxs for all 3 of the doctors.

1. Currently it looks like we have to assign one nurse to prescribe only for one doctor. Is there a way all of our nurses can write Rxs for all of us?

2. As I think you were describing above, can you explain how you have the nurses save the Rxs for you to review them before signing off/ sending them? I think this is related to importing the Rxs as you were describing above, but I don't know how to do that. We are on the newest version.

Thanks!