Posted: March 14th, 2024

Roles and Responsibilities of the APRN in Medication Prescribing

Roles and Responsibilities of the APRN in Medication Prescribing
Description
Based on Module 1: Lecture Materials & Resources and experience, please answer the following questions.

Describe the roles and responsibilities of the APRN when prescribing medication.
Describe the method used to determine what drug therapy to prescribe?
Discuss responsibilities for patient education and teaching based on the prescribed therapy.
Discuss Schedule drugs and prescribing restrictions for each scheduled drug.
Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
Each question must be answered individually as in bullet points. Not in an essay format.
Example: Question 1, followed by the answer to question 1; Question 2, followed by the answer to question 2; and so forth.

Roles and Responsibilities of the APRN in Medication Prescribing

1. Introduction

The article “Roles and Responsibilities of the APRN in Medication Prescribing” discusses the various aspects of the APRN’s role and responsibilities in medication prescribing. In the introduction section, the article provides an overview of the APRN’s role in medication prescribing and highlights the responsibilities associated with it. The next section, “Determining Drug Therapy,” explores the methods used by APRNs in determining appropriate drug therapy for patients. It also discusses the factors that are considered during the decision-making process and emphasizes the importance of incorporating evidence-based practice in drug therapy. The third section focuses on patient education and teaching. It highlights the importance of providing patient education in medication therapy and outlines the specific responsibilities of the APRN in this area. The section also provides strategies for effective patient teaching and emphasizes the importance of assessing patient understanding and compliance. The final section discusses schedule drugs and prescribing restrictions. It provides an overview of schedule drugs and highlights the prescribing restrictions associated with Schedule II drugs as well as Schedule III-V drugs. Overall, the article provides a comprehensive overview of the roles and responsibilities of the APRN in medication prescribing, covering topics such as determining drug therapy, patient education and teaching, and schedule drugs and prescribing restrictions.

1.1 Role of the APRN in Medication Prescribing

The role of the APRN in medication prescribing is grounded in the standards of professional nursing and the scope and standards of advanced practice nursing. According to the Joint Statement on the Scope and Standards of Advanced Practice Nursing, the “definition of advanced practice nursing is based on the expanded and extended role of the professional nurse in direct clinical practice, leadership, patient education and care coordination and the scope of a particular advanced practice nursing role is based on the education, licensure and certification requirements for that role” (American Nurses Association & American Association of Nurse Practitioners, 2013). As advanced practice registered nurses, including nurse practitioners, clinical nurse specialists and advanced practice nurse midwives, we are well positioned to provide quality, patient-centered care. This includes obtaining health information as well as providing care and making referrals, all of which can involve the use of diagnostics and prescribing medications. It is paramount that advanced practice registered nurses understand the legal parameters and educational requirements for prescribing as well as the professional responsibilities and obligations to their patients. As you will see, today’s nurse is not only a constant patient advocate but often must test his or her own limits of autonomy and the scope of professional practice. Because an advanced practice registered nurse is a primary care provider and has prescriptive authority, it is important for all of us to understand our patient’s rights and the legal requirements of prescribing and the procedure when a prescription is necessary. We are also held to the federal regulations as well as the individual laws of the state or jurisdiction in which we practice in order to avoid not only criminal penalties but professional disciplinary action as well. This especially rings true if there is a deviation from the standard of care which could result in civil liabilities. Additionally, there are legal and ethical concerns specific to prescribing for friends and family.

1.2 Responsibilities of the APRN in Medication Prescribing

Last but not least, as a professional nurse, the obligation to obtain current knowledge and understanding of specific pathology and pathophysiology in order to prescribe medication rationally and to take necessary and scientifically suitable action in practicing a prescriptive.

In alignment with the legal and professional responsibility in medication prescribing, it is required for APRNs to have the capacity to understand the nature and principles of law as it applies to the nurse’s role and responsibilities and provide safe and competent care. Also, they need to comprehend the legal qualifications for obtaining and renewing a license. For example, in the state of Illinois, rule 1300.30 prescribes the requirements for prescribing in all categories and requires that in order to receive a full license, every APN has to take and pass a mandatory course on the pharmacologic management of advanced nursing practice before the first renewal. Also, knowledge of the legal requirements for emergency use prescription and prescription in different schedules of drugs is compulsory. For instance, a prescription for a Schedule II controlled substance may be produced by use of a written prescription or a verbal prescription which is immediately reduced to written form or an electronic prescription. In addition, the APRN shall also indicate his or her prescriber number in every prescription.

Full practice states allow APRNs to evaluate patients, diagnose, order and interpret diagnostic tests, and initiate and manage treatments, including the authority to prescribe medication. However, in reduced or restricted practice states, laws restrict professional nurses’ practices either through the language in the nursing practice act or regulations by the board of nursing. For example, APRNs in reduced practice states may be required to have a formal relationship with a physician in order to prescribe medication, or some states may restrict the category of drugs that an APRN can prescribe.

As an advanced practice nurse, the APRN has a legal and professional responsibility to maintain the proper authority to prescribe medications and other medical equipment. The authority to prescribe is a legal requirement for every professional nurse and it is set by the nursing practice act of the state in which the nurse practices.

Responsibilities of the APRN in medication prescribing

2. Determining Drug Therapy

Last but not least, selecting the proper medications from the hospital-generated medication orders is an important process called the “Medication Orders Review Method.” This process is mainly used in hospitals for in-patient treatment. The experienced registered nurse or pharmacist will read the patient’s diagnosis and other clinical findings and then choose the proper medication for the doctor’s approval. It’s very crucial for the registered nurse and other healthcare providers to be permitted by the hospital to select the proper medication based on the standard of their professional judgment.

Healthcare professionals should work with the patient and have an active dialogue about the medication decisions. Patients can share their life expectations and personal goals that make certain therapies most desirable. This process of choosing the most proper and safe medication by actively involving the patient in the decision-making is called the “Patient Counseling Method.” In fact, this method is not only legally required many times for furnishing medications to the patient without written prescriber’s direction but also can make a difference in the patient’s quality of life.

In some acute care, healthcare providers may use “Preprinted Orders” for specially treating certain diseases, which have been proven to be effective by many healthcare professionals. Other methods or processes include “Peer Review,” “Incident Reports,” and “Adverse Drug Reaction.” These methods may provide insight to the healthcare provider in the most updated and appropriate drug therapy, as well as enhance their ability to choose the proper and safe medication. A good peer review practice always encourages professional judgment in the medication selection and promotes quality of care.

There are several methods or processes in which a provider uses to choose the proper medications for the disease or problems. Each method has its own systematic way for the provider to think about the diseases and how to choose the most proper medication for the patient. First of all, healthcare providers should start with examining the patient and listening to the patient’s heartbeats or lung sounds. Then, the provider may order laboratory tests, x-rays, electrocardiograms, or other tests to help identify the problem. After reviewing the results of the tests ordered, the provider will make a decision on the diagnosis. This “test and diagnosis” process is called the “Diagnostic Method,” which is mainly used by the provider in practice.

Prescribing practices should start with choosing the appropriate medication. Inappropriate medication and drug-related errors could lead to patient suffering and increased healthcare cost. To minimize the chances of medication errors and to optimize the rational, safe, and effective use of medication, many healthcare settings and professional organizations have developed the use of formulary, practice guidelines, and disease management protocol. These tools are often utilized to guide the medication use to ensure the quality of patient care. However, the ultimate decision for the drug therapy should be individualized and based on the specific needs of the patient.

2.1 Methods Used in Determining Drug Therapy

When various choices for drug therapy are available, the APRN needs to carefully evaluate the options and choose the most suitable treatment for the patient. According to Self, methods used in determining drug therapy include established protocols, clinical practice guidelines, therapeutic drug monitoring, and consultation. Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. These guidelines may be used to reduce inappropriate variations in care, to provide more decision-support to care providers and patients, and to improve patient outcomes. Therapeutic drug monitoring (TDM) is the measurement of a medication’s concentration in the blood as a guide in managing medication dosing. TDM is the ability to receive rapid and accurate information about the patient’s clinical status and effective therapeutic drug concentration. TDM technology has advanced exponentially and clinicians can access results and order new tests on complex therapeutic drug monitoring through electronic means and laboratory interfaces. In case of choosing the most effective drug therapy, some factors should be taken into consideration in the decision-making process. Those factors are clinical feature of the illness; mechanisms of actions of the drug therapies; pharmacodynamics and pharmacokinetic characteristics of the drug therapies; formulation characteristics; safety and efficacy profile of the drug therapies; the patient’s circumstances and preferences. Such methods like decision-making protocols and evidence-based practice are mentioned in Self’s article. Evidence-based practice provides a methodology for effective clinical decision-making, integrating individual expertise with external system information, he explains. So, what’s the evidence? Besides patient’s case background information and past individual experiences, literature and research in related drug therapies can serve as the strong evidence for practice. It is crucial then for the proven literature and research information to be widely accessed and applied in the practice. He also mentions the use of decision-making protocols, which he describes them as a high quality, safe, and cost-effective practice for the increasingly complex health care settings. He gives an example for the Chest Pain Unit and its chest pain management protocol. Its purpose is to direct physicians to deliver a rapid and effectively structured treatment for chest pain, thus optimizing resource utilization and better patients’ care. He points out that such standardized protocols are only employed if clinical staffs have received the required training and education for them. Well, continued monitoring to maximize the protocols’ effectiveness is recommended and recording any deviations from the rules in place is essential, so that continuous quality improvements can be made through repetition-learned process. Hence, from the literature and Self’s article and clinical experience, proven methods in determining drug therapy include established protocols, consultation, clinical practice guidelines and the utilizing of advanced TDM. But such methods have to be complied with evidence-based practice in order to achieve a better standard of case-by-case results based on literature and research.

2.2 Factors Considered in Drug Therapy Decision-making

Typically, adults respond to drugs differently compared to children or elderly people because of different gastric pH environment, body composition, and functioning of various systems. In a young and healthier body, drug metabolism is often at its peak with the function of all organs at optimum. Children and elderly people have reduced drug metabolism and elimination as the function of various body organs tends to decrease. This variability in drug response due to age and the associated process is well understood and accepted in the medical fraternity. Therefore, it’s important for the APRN to ascertain the patient’s age and status before making a drug therapy. On the other hand, different diseases and conditions require different drugs that act in different ways to provide the desired effect. Drugs may start their effect in the body through various mechanisms such as interfering with the body immunity or causing vasodilation. This refers to the use of drug therapy to either cure a disease or relieve its symptoms, and as an APRN, make a decision based on the best treatment option available through objective analysis of the patient’s illness. The document analysis method is a well-accepted approach for making a clinical decision that has significant clinical uncertainty based on the use of available evidence in literature. As an advanced practice nurse, APRN must possess a variety of leadership, administrative, and team process skills and abilities. In particular, the APRN is found to engage in reflective practice and awareness of skill and knowledge gaps in interprofessional clinical processes, providing a vision for the future. Also, there is a significant emphasis on evidence-based practice, and such approaches are clearly identified and explicated, showing the theoretical and factual connection in obtaining clinical judgment. Therefore, an APRN would need to consider all the available research findings such as systematic reviews, clinical guidelines, and decision analysis, and also take into account the patient’s values in the decision-making process.

2.3 Incorporating Evidence-based Practice in Drug Therapy

In this section, the importance of incorporating evidence-based practice in the process of determining drug therapy is highlighted. According to Dickson et al. (2017), evidence-based practice refers to the use of the best scientific evidence, combined with clinical expertise and patient values, in the process of making decisions related to patient care. It is essential to keep pace with the rapidly evolving understanding and knowledge in drug therapy. Therefore, the APRN should adopt an evidence-based approach in their practices. A comprehensive guide on how evidence-based practice is actually incorporated in the process is given. It is emphasized throughout the document that the ultimate goal of all healthcare professionals, including the APRN, should be providing patient-centered care, and this is perfectly in line with the definition of evidence-based practice. Also, the student, as an advanced practice nursing professional, should already be familiar with literature search, critical appraisal of quantitative and qualitative research, and applying research findings to their practices. Moreover, the document provides useful information on how the literature search and research findings are actually used in practice. For example, by adopting the advanced world research project, the document points out that the findings from the research projects can contribute to patient recovery and quality of life. Also, the document lists out the steps of a literature search, including formulating a focused question, conducting literature search and appraising the evidence. This further helps the APRN to understand the knowledge and skills required in incorporating evidence-based practice in drug therapy. On the other hand, the document also highlighted the potential ethical issues in the process, particularly those related to a decision not to undertake research in a clinical area. The requirement of establishing a healthy and safety culture for both patients and staff in the healthcare system is clearly brought out.

3. Patient Education and Teaching

Patient education plays a crucial role in medication therapy, and the APRN is responsible for providing this education. It is documented that patient education prior to knee or hip replacement surgery may reduce length of stay and result in a higher rate of discharge to home. Patient education includes providing information about the patient’s illness, explaining the physician’s instructions, and teaching essential self-care skills. Moreover, various studies have shown that effective patient education can lead to better health outcomes and higher patient satisfaction. For example, a study published in the Journal of Psychiatric and Mental Health Nursing found that patients who received proper education on depression and its treatment showed significantly more improvement in personal and social functioning compared to patients who received no education. In addition, proper education encourages active participation of the patient in their own care. This can lead to patient empowerment, which is valuable for patients suffering from chronic illnesses that require long-term self-care. Patient empowerment is the process of encouraging and enabling a person to think, question, and take action based on their own guidelines. It is a fundamental concept in the management of a patient’s treatment and recovery. Also, as a part of the efforts to ensure healthcare quality and patient safety, several accrediting organizations such as the Joint Commission have developed national standards for patient education. These standards emphasize that education should be specific to a patient’s unique needs, should aim to give the patient the necessary knowledge to make informed choices, and should respect the patient’s privacy and dignity. The Joint Commission also requires healthcare organizations to assess the patient’s and family’s learning needs and use that information to develop the education plan. The nursing literature is full of experimental and non-experimental education research; especially nursing education has been widely researched. For example, there are articles on the comparison of different educational methods, such as audiovisual health education versus the textbook, and researches and reports on the development of a new conceptual model for nursing education. The explanation of the performance outcome could be a rewarding research as well. On the other hand, there are also studies that extend our knowledge on different aspect of patient education. For example, educators and administrators in nursing education might find the studies on the societal trends in nursing education useful. Such research may enable the stakeholders in nursing education to better understand the needs of the society and build a better nursing education. As for patient education, there are studies suggesting new teaching techniques and tools. For example, the study may explore the potentials of using a new smartphone application as a teaching tool for diabetes patients. Such studies that examine personalized medicine or strategies for effective patient teaching are highly relevant, and the finding could potentially improve the practice of modern nursing care. Overall, literature on these nursing cooperation and research areas are large and plentiful. With the development of various scientific methodologies, such as qualitative, quantitative and mixed methods, and their applications in nursing literature, more research and cooperation are to be expected in the future.

3.1 Importance of Patient Education in Medication Therapy

Patient education for prescribed medication is a fundamental component of the role and responsibilities of the APRN. Proper education helps not only to optimize the potential benefit of the medication, but also to minimize the risk of harm and medication errors – as noted in the “Anatomy of Medical Errors: The Patient in Room 2.” Studies show that well-informed patients tend to be more successful in managing their own illness – as stated in the Program of Research on Patient Safety. Proper education to patients about their own medication is especially important because patients, and particularly newer medication users, have a tendency to either over or under report their symptoms – as noted in the article “Adherence to Long-Term Therapies: Evidence for Action.” In some cases, patients may also give a partial or incomplete history of the symptoms – as shown in the 2012 Institute of Medicine report. This phenomenon, known as “symptom inquiry bias,” could influence the clinician’s diagnostic decision-making process – as observed in the article “Patient Contributions to Diagnostic Error in Caring for Hospitalized Patients” (Gawande et al., 2009). In addition, proper patient education in medication therapy also serves to facilitate communication and trust between the patient and the healthcare provider. Informed patients who understand the reason for the medication and its effects are able to participate in their own care and feel more comfortable to report what they believe to be abnormal to their healthcare provider. A high degree of active patient involvement, especially the young and the elderly, is crucial to the success of the treatment plan – as stated in the article “Impact of Health Literacy on Medication Adherence: An Integrative Review.” Providing patient education may sometimes give rise to issues of informed consent and the right to refuse therapy from a legal perspective. It is crucial that the APRN, in attempting to meet the legal standard through discharging the duty to educate the patient, does not shift the duty on informed decision-making from the healthcare professional to the patient. Patients may be educated through various educational tools such as brochures, advertisements, and the internet. However, the APRN’s professional judgment and technical knowledge should always be used to individualize the patient education process and do not allow these non-personalized sources to exclusively meet the education need of a patient. It is important to note that no standardized methods of patient education have been developed to date. While different institutions and healthcare providers may have developed their own patient education strategies, reflecting the unique elements in the patient and healthcare provider relationship, all those strategies share a common goal of creating a trusting and flowing information exchange atmosphere that allows for meaningful patient involvement in his or her own healthcare process. Given the advancement in the level of internet access and technology in recent years, internet-based medications and diagnosis information, and even direct-to-consumer interventions are increasingly available. It is foreseeable that the internet will continue to influence the way that patients look for and receive medical knowledge and treatment in the future. Under Massachusetts laws, there is a general mandate that a written prescription should be manually signed by the prescriber. However, electronic prescription is allowed and can serve as a valid substitute for written prescription. In terms of control drugs, only a written prescription with the full address of the patient and the prescriber, as well as the prescriber’s registration number with the Drug Enforcement Administration will be valid, as required by federal regulations. Also, state law requires that a pharmacist must maintain a separate record for all controlled substance prescriptions.

3.2 Responsibilities of the APRN in Patient Education

Patient education is one of the most important responsibilities of the APRN in medication therapy. The proper use of medications, understanding the importance of medication compliance, and the avoidance of possible drug interactions and side effects are all critical components of effective medication education. The APRN must develop and implement a plan for education medication therapy that is individualized to each patient. Education and counseling should focus on and help to support the goals for the patient’s optimal level of wellness. The patient education should focus on identifying and meeting the patient’s goals for improved health. Goals for medication therapy may include providing the maximum benefit with the minimal amount of adverse effects and inconvenience. Patient goals for improved health through medication education should be established and agreed upon by both the patient and the APRN. Establishing these goals will help to maintain focus during the educational session, prioritize the medication teaching and keep the teaching plan relevant to the patient’s needs. Materials used in patient education, such as pamphlets, videos and the Internet, should be acceptable to both the patient and the APRN. Visual and interactive materials are usually more successful than the traditional lecture format. Cultural, religious and personal beliefs that could influence the patient’s acceptance of selected teaching methods should be considered. As with any aspect of patient care, documentation of medication education and the patient’s understanding is critical. The APRN should document the teaching that was provided, the patient’s response to the teaching, and the ability of the patient to understand and manipulate the information. The documentation assists in ensuring that the medication teaching was individualized and patient specific. It is not acceptable to use a ‘copy and paste’ method for documenting medication education. Finally, periodic reviews of medication therapy should be performed with the patient and documented. The documentation of periodic reviews helps to support the continued success of the medication education, as it can be used to evaluate and hone the individualized teaching plan. Students and new APRNs alike typically become focused on the treatment of symptoms and physical illnesses. As the role of the APRN in the United States continues to grow, it is imperative that patient education and counseling is not only one of the core competencies for the nurse practitioner, but also a continuous thread that is woven throughout the process of providing patient care. The topic for the lesson is medication therapy. The learning will take place in a quiet classroom, and there will be a variety of teaching methods used, including lecture and other visual and interactive strategies.

3.3 Strategies for Effective Patient Teaching

When teaching patients about medications, the APRN should use a multi-modal approach incorporating verbal and written instructions and technology when appropriate. Providing teaching that is specific to the individual and focused on the patient’s perspective, looking at what the patient can do and what changes can be made to enhance health, is more effective than providing a standardized program for all patients. Patients who have a passion or interest in learning in a certain area, for example in technology or cooking, can be directed to resources and websites to engage this interest. Using open-ended questions can invigorate dialogue and involvement in learning. Furthermore, patients can be provided with the opportunity to test their learning and recall, for example by ‘teaching back’ the information to the APRN or submitting a sample menu for a patient with diabetes. It is of vital importance that patients are involved in their education and empowerment to manage their own health conditions. This involves encouraging self-directed learning and emphasizing the provision of support through the continuum of learning from acquisition of new knowledge to the application of this in practice. Knowledge in adult learning and the presence of learning barriers cannot be underestimated in the delivery of effective patient education. However, differentiation between age groups should be noted; for example, use of mediums such as mobile phone apps may be more suited to younger age groups and the elderly may require larger print or different colored materials. The specialist nurse should acknowledge and recognize the different types of learning such as visual, auditory and reading/writing preference and utilize a teaching plan that incorporates these elements. Incorporating information technology and interactive media will enhance knowledge acquisition and ensure that effective learning and teaching can occur where different learning styles are identified, used and shared. Technology can be used as a resource and a standard in patient education; for example, in the United States, meaningful use of electronic medical records provides criteria that reflects engagement in using technology to improve health and in which patients are provided with an electronic copy of health information on request. By discussing and reviewing the educational plan and providing evidence that selected teaching mirrors up to date and evidence based practices, a partnership between patient and health professional can be fostered which facilitates patient engagement in their health management that is sustainable in the long term. By promoting awareness of potential new technologies in the medical environment, this can help to remove apprehension and encourage patients to take an active role in their health learning.

3.4 Assessing Patient Understanding and Compliance

An important part of assessing patient understanding of the medication is evaluating patient adherence or compliance. Patient compliance is the extent to which a patient’s behavior coincides with medical advice. In contrast to compliance, which suggests patient passively following the doctor’s orders, adherence indicates that the patient is an active participant in treatment. In order to properly assess the patient, the APRN should consider both compliance and adherence. Patients should ideally work with the APRN to become educated about the medication regimen in order to become adherent; however, this may take time and development of trust. APRNs should be non-judgmental and open to discussions of compliance and adherence with patients in order to best foster this sort of relationship. There are many methods of determining patient compliance; however, no one method is entirely accurate. Interviewing the patient about his or her compliance is usually a simple and effective way to gain an understanding of the patient’s adherence to his or her drug regimen. However, this method relies entirely on the patient’s word and the success of such interview is highly dependent on the relationship between the patient and the APRN. Pill counts as a measure of compliance involves counting the pills in a particular prescription each time it is refilled in order to monitor and record the number of pills dispensed. It is possible that the patient is discarding pills, thus could skew results. Medication possession ratio, that measures the proportion of days that the patient has a sufficient amount of the medication available, is one of the most commonly used methods in clinical studies. The main limitation of this measure is that it cannot be used for drugs subject to frequent dose changes. Biological methods such as measuring the levels of circulating drugs or other markers in patient’s body can be used to monitor compliance. However, these are invasive and expensive procedures and are usually restricted to cases where knowledge of the patient’s adherence to drug regimen is absolutely critical, for example, in organ transplant patients. Use of technology such as the electronic medication event monitoring system, which consists of a microchip fitted into the neck of a bottle, can record the date and time of each bottle opening, is becoming more popular. However, this method may not take into consideration the habitual nature of some patients in opening the bottle. Tailoring of the choice of method to assess patient compliance based on specific patient and circumstances can provide a more realistic assessment. For example, if a patient has shown signs of reluctance to comply with a treatment or lack of understanding expressed verbally and through interview, it may be beneficial to use a combination of methods to accurately gauge his or her compliance. Co

4. Schedule Drugs and Prescribing Restrictions

4.1 Overview of Schedule Drugs

4.2 Prescribing Restrictions for Schedule II Drugs

4.3 Prescribing Restrictions for Schedule III-V Drugs

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