A family nurse practitioner employed in a busy primary care office
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 1 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 practice.
Case Study Questions:
What are the potential ethical and legal implications for each of the following practice members?
Medical assistant
Nurse Practitioner
Medical Director
Practice
What strategies would you implement to prevent further episodes of potentially illegal behavior?
What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice.
A scholarly resource must be used for EACH discussion question each week.
Sample Solution
Ethical and Legal Implications:
Medical Assistant (Stephanie):
- Ethical Implications: Stephanie might have violated patient confidentiality by dispensing medication without a proper provider-patient encounter.
- Legal Implications: Stephanie could face disciplinary action from her certifying body and potentially lose her license depending on state regulations. Additionally, there could be legal repercussions for unauthorized practice of medicine if refilling a prescription without a provider's authorization is deemed practicing medicine.
Nurse Practitioner (You):
- Ethical Implications: You have a responsibility to ensure the appropriate use of your DEA number and to document all patient encounters. Failing to address Stephanie's actions could be seen as a breach of your ethical obligation to provide safe and competent care.
- Legal Implications: You could face disciplinary action from your licensing board for improper prescribing practices.
Medical Director:
- Ethical Implications: The Medical Director has a responsibility to ensure the practice adheres to ethical and legal standards of care. Failing to oversee staff practices could be seen as a breach of their leadership role.
- Legal Implications: The Medical Director might face legal repercussions if the practice is found to be negligent in its oversight of staff activities.
Full Answer Section
Practice:
- Ethical Implications: The practice has a responsibility to ensure patient safety and to operate within legal boundaries. Refilling prescriptions without proper provider evaluation could put patients at risk and damage the practice's reputation.
- Legal Implications: The practice could face legal action for improper prescribing practices and potential HIPAA violations if patient confidentiality is compromised.
Strategies for Prevention:
- Develop clear policies: Implement written policies and procedures regarding prescription refills, outlining the required steps for authorization and documentation. Ensure all staff understand these policies.
- Regular training: Provide ongoing training for medical assistants on proper procedures for handling prescription refill requests, emphasizing the importance of not dispensing medication without a provider's authorization.
- Audit System: Implement an audit system to randomly review prescription refills, ensuring proper documentation and authorization.
- Communication and Transparency: Encourage open communication among staff. If a medical assistant is unsure about a refill request, they should feel comfortable discussing it with a provider.
Leadership Qualities for Positive Change:
- Integrity: Demonstrate ethical leadership by upholding high standards of practice and addressing any concerns regarding staff behavior.
- Accountability: Hold yourself and all staff accountable for adhering to policies and procedures.
- Transparency: Foster an environment of open communication where staff feel comfortable reporting concerns without fear of retribution.
- Collaboration: Work collaboratively with staff to develop and implement new policies, encouraging their participation and feedback.
Scholarly Resource:
American Academy of Family Physicians (AAFP). (2023). Principles of Family Medicine. https://www.aafp.org/home.html This resource provides ethical principles for family physicians, which can be extended to the broader primary care team.