Advanced Primary Care of the Family
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
- Mercedes Yumar
Advanced Primary Care of the Family I
Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations?
Controlled substances are those drugs or medications that have the probability for being misused from their original purposes. ARNPs should prevent the consequences of misused drugs in their patients. When prescribing drugs, providers must understand drug Schedules and to know which drugs are classified according to the Schedules of Controlled Substances. The physician should also be aware with the laws and guidelines surrounding prescription of substances within each Schedule, which organize drugs according to purpose and risk for a substance use and addiction disorder. (Vallerand, Sanoski, &Hopfer, 2017).
When considering a specific patient needs prescription for a controlled substance, Nurse practitioners should prevent misuse and substance abuse performing a detailed examination of the patient, patient’s medical history, history of substance abuse, among others. If the patient has pain, for example, physician needs to assess the pain levels. The provider should do reconciliation of medications. As ARNPs, we should consider other alternatives treatment and adjuvants non pharmacological therapies. If it is necessary, the prescribing provider should avoid prescribing the controlled substance and consult a specialist. (ACPM, 2011).
Because of the hazards associated with misuse of controlled substances, the growing incidence of deaths from overdose, and the economic burdens that addiction and dependence have on the healthcare system, it is important that prescribing providers be acknowledged about the difficulties of prescribing controlled substances for pain and other health conditions. Prescription drug monitoring programs have been developed in our country. Communication is essential prescribing controlled substances. Communication should be maintained with the patient, other providers, and pharmacists, to ensure that providers are successful helping patients. (O’Brien, 2014).
References
American College of Preventive Medicine. (2011). Use, abuse, misuse & disposal of prescription pain medication clinical reference. Retrieved from http://www.acpm.org/?UseAbuseRxClinRef.
O’Brien, C. (2014). Managing patients with a history of substance abuse. Can Fam Physician. 60(3): 248-250. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952760/
Vallerand, H.A., Sanoski, C., &Hopfer, D J. (2017). Davis’s drug guide for nurses (15th Ed.). Philadelphia, PA: F.A. Davis.
- Maria Arista Salado
Nursing experts could as well as must help fill a void in primary care. Individuals frequently see family service providers with issues like sore throat, back anxiety or pain. The nurse is appropriately educated, has passed a national certification examination and it is licensed to cope with these problems. Nevertheless, it’s just in states that are certain that these APRNs can easily recommend the required treatment for these individuals (Block, Vito, & Higgins, 2018). The practitioner may well not have the ability to meet up with the patient ‘s needs in states with rigid laws that restrict the best to recommend APRN. In these states, the APRN should send the individual or even check with a physician to meet the patient’s health-related needs, postponing medical treatment.
In the opinion of mine, no matter that prescribes, any person is able to abuse the power. Public health advocates are frequently focusing on illnesses as well as deaths brought on by the inappropriate use of controlled substances – especially opioid pain relievers. But there are reasons that are many because of the increased prescriptions and also the prevalence of abuse. In the mid 1990s, advocates of persistent discomfort therapy started to argue that pain was under treated and also urged clinicians being much more liberal in the treatment of theirs (Block, Vito, & Higgins, 2018). Additionally, many new formulations of opioid representatives have grown to be available, with claimed advantages in analgesia. But possibly as vital as an insufficient prescription has grown. The most terrible kind of this particular prescription happens in so called pill facilities, wherever completely qualified medical professionals with legitimate Drug Enforcement Administration (DEA) numbers write prescriptions which supply huge quantities of potent painkillers to unique patients. This kind of pain clinics work younger individuals, work on money and attract clientele from a big geographic region (Block, Vito, & Higgins, 2018). This could additionally occur with a sophisticated nurse who’s got the prescriptive energy for this particular.
Drug stores have a role to play in the supervision of prescriptions for opioid analgesics and controlled substances particularly. Pharmacists are needed under the Controlled Substances Act to evaluate individuals to make certain the adequacy of any prescription for controlled substances. Additionally, boards of status pharmacies manage the distribution of opioid pain relievers along with other controlled substances, in the discretion of pharmacists (Moyo, et all, 2019). Nevertheless, in many instances of prospective abuse, an individual is confronted by pharmacists who’s got a legal prescription from a qualified physician and also has ability to access hardly any different basic info. This causes it to be hard for specific pharmacists to make use of their very own partly informed judgment to recognize prescriptions originating from a health care professional in a tablet factory. Controlled drug monitoring applications (PDMP), the state electric sources utilized to monitor the doctor prescribed as well as distribution of controlled medications to individuals, are great tools for stopping & identifying drug abuse, though investigation on the effect of these programs is now mixed, the usage of PDMP in certain states was connected with reduced rates of overdose and prescription of opioids, although troubles of best practice, simplicity of use as well as interoperability continue to be not solved (Moyo, et all, 2019).
References
Block, M. M., Vito, G. F., & Higgins, G. E. (2018). Strengths and Weaknesses of Prescription Drug Monitoring Programs: A Focus Group Assessment of Law Enforcement Officers. Deviant Behavior, 39(5), 576-586.
Moyo, P., Simoni‐Wastila, L., Griffin, B. A., Harrington, D., Alexander, G. C., Palumbo, F., &Onukwugha, E. (2019). Prescription drug monitoring programs: Assessing the association between “best practices” and opioid use in Medicare. Health services research, 54(5), 1045-105
Daylamis Gonzalez
- Daylamis
Discussion Board
Question 1:
Issues may arise with prescriptive authority of controlled substancesPrescriptive authority is described as the independence of certified nurses to prescribe drugs, even the controlled substances without any barriers put in place. This can have detrimental effects not only to them, but also to the community. It has come to people attention that the lack of barriers will lead them to prescribe to family and friends; this has been termed as a bad idea because it tends to lead to addiction. Moreover, the clinicians might end up managing prescription errors and keeping them a secret because they know it would be damaging to their career and job (Onlinenursing.duq.edu, 2020). The most common is the tendency of prescribing pain medication such as the opioids. This medication was used for treating chronic and disabling pain but they end up causing a drug-addiction pandemic which will lead to loss of innocent lives. Sometimes the nurses themselves will get addicted because the lack of barriers will allow for self-prescription.
Question 2:
How you may avoid these situations?First of all, the best way of avoiding these situations would be by avoiding and preventing the law from allowing the independence authority. If the practice is not allowed, then the challenges that are associated with it will not be available in any case. However, if prescriptive authority is legalized or allowed in any state, then the following ways should be used to avoid the challenges; first, I would prevent myself from using the drugs. This will help me to not be addicted in any way hence chances of using it would be minimal. Also, I would not allow any situation to allow my family and friends to sway me into prescribing to them the controlled substances. Avoiding the temptations will also be of great help because people tend to give in whenever they get the urge. But all in all, self-control and good judgment would be my daily portion (Tyrell, R., 2019).
References:
Chedekel L. (2015, April 6). High-prescribing nurse surrenders drug licenses. Connecticut Health Investigative Team.
https://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/
Onlinenursing.duq.edu. (2020, April 7). APRN’s role in ethical prescribing | Duquesne University. Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/
Tyrell R. (2019, May 6). Do nurses with substance use disorder need to lose their licenses? New Hampshire is trying a different approach. Advisory Board. https://www.advisory.com/daily-briefing/2019/05/06/nurse-addiction
- Eduardo Soto Quinones
05/30/2020
An Advanced Registered Nurse Practitioner (ARNP) is a nurse who is registered and has completed a graduate-level of the education program. The primary responsibilities of this ARNP are chiefly to care for the patient and as well as registered nurse anesthetists, clinical specialists, and others being midwives. Having been trained at a graduate level of education they have all the skills and qualities to evaluate patients, diagnose illness, and order and prescribe medication to the patients. The ARNP, therefore, is qualified to be called the physician. The prescription of drugs by the ARNP may include the prescription of controlled substances. However, there are disciplinary actions that govern the ARNP based on the prescription of controlled substances. In that connection, the ARNP should be able to meet their practice standards to avoid being penalized.
However, the primary role of the ARNP is to care for the patients and to prescribe and order medication, there are some basic laws that an ARNP should strictly adhere to refrain from any form of discipline. The areas in which the ARNPS should take caution while executing is on matters of prescribing the controlled substances. Much care should be considered in the handling of controlled substances that may result in issues like an advertisement of unprohibited drugs by the medical practitioners taking the advantage of their responsibility of prescribing and ordering drugs for the patients. Also, the ARNPS may take advantage of ordering-controlled substances and prescribing them to the patients in their stations for their benefits. The prescription of these controlled substances could result in addiction or the wrong prescription of medicine to a patient.
Some ARNPS could prescribe the drugs to which could be an overdose as well wrongly prescribed as the case in Derby’s advanced registered nurse practice. ARNPs must carefully examine patients to avoid prescribing a wrong dose to a patient for a wrong illness.
References
Farrell, K., Payne, C., &Heye, M. (2015). Integrating interprofessional collaboration skills into the advanced practice registered nurse socialization process. Journal of Professional Nursing, 31(1), 5-10.
Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., … & Weiner, J. P. (2019). Advanced practice nurse outcomes 2000-2018: a systematic review. In Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK).
- Gretel Alfonso- Discussion 4
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As a future Nurse Practitioner I can anticipate several issues that can happen with prescribing authority of controlled substances. For example, as a healthcare professional I have had many encounters with patients who are addicted to pain medication or narcotics and abuse them. Therefore, having the ability to prescribe them will mean that these patients will be coming around and I will definitely have encounters with them as my patients. I also anticipate people that might come in expecting me to prescribe a narcotic medication right away for their pain which is obviously not how it works. After reading the article provided, I have realized that it is important to pay special attention to what is prescribed to patients, and the frequency according to the patient’s medical history and practice you prescribe at. I believe that the Heather Alfonso the nurse practitioner from Connecticut thought that she could get away with strong medication prescribing such as narcotics because worked in a pain center (Chedekel, L.2015, April 6).
Since many of these issues are already anticipated due to there being more than people expected with narcotic addiction or abuse, I plan on making sure I follow the rules for prescribing as a nurse practitioner as strictly as possible while my patient’s safety is secured. I will also make sure that when a patient comes reporting pain that it is factual information, I will make sure that the patient doesn’t have any substance abuse issues by consulting it with the doctor on staff who has had more experience with the patient in the past. Also, if I have any doubts, I will always ask colleagues such as other nurse practitioners with more experience that work in the same health care clinic for advice. Lastly, I will make sure that the correct medications are being prescribed according to patient medical history, diagnosis, signs and symptoms. I believe that losing any licenses in the health care profession could be very easy if you aren’t strict with your work and how service is being delivered. According to a recent study, there has been data that confirms for health care professionals such as PA’s, Nurse Practitioners, MD’s have met at least one definition of overprescribing narcotics with PA’s and NP’s making for most of the statistics (Opioids – prescription opioids; studies from vanderbilt university medical center provide new data on prescription opioids (opioid prescribing by primary care providers: A cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns. 2020, May 11). In conclusion, being an efficient Nurse Practitioner is my ultimate goal and prescribing the right medications for the right reasons to the right patient is one way that I am planning to accomplish it in the future.
Reference
Opioids – prescription opioids; studies from vanderbilt university medical center provide new data on prescription opioids (opioid prescribing by primary care providers: A cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns). (2020, May 11). Managed Care Weekly Digest Retrieved from
https://search.proquest.com/docview/2402239143?accountid=158399
Chedekel, L. (2015, April 6). High-Prescribing Nurse Surrenders Drug Licenses. Retrieved May
26, 2020, from http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/
- Manuel Cabrera
Discussion 4: Manuel M Cabrera
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Discussion 4
Caring for patients with pain challenges prescriber nurses and pharmacists given the prescriptive authority legal guidelines for controlled substances. The case of the Derby nurse reported for making high amounts of prescription of narcotics attracted the attention of the Drug Control Division of the Department of Consumer Protection. According to Chedekel (2015), the drug control division identified the APRN, Heather Alfonso, as one of the top 10 prescribers of controlled substances. The department also noted that Alfonso prescribed Schedule II drugs frequently, wrote the highest number of prescriptions in Connecticut, and more than 94% of her patients received at least one Schedule II drugs (Chedekel, 2015). A review of Alfonso’s prescription culture may draw disciplinary actions from the drug control department due to her careless prescription of controlled substances, patient overdose of controlled substances, inadequate patient screening prior to prescriptions, abuse of her prescription authority, and disregard of drugs control guidelines.
Nurses and pharmacists that prescribe controlled substances uncontrollably come under scrutiny by the drug control department and can lose their licenses just as Heather Alfonso. However, care providers can avoid the over-prescription of controlled substances by evaluating and screening patients properly before prescribing controlled substances. According to Preuss, Kalava, and King (2019), pain evaluation allows care providers to identify the nature of a patient’s pain, the radiation of the pain, its site, onset, progression, duration, and severity. Additionally, a care provider should assess pain-relieving factors prior to prescribing controlled substances to patients (Preuss et al., 2019). Through proper patient screening and evaluation, nurses and pharmacists can limit the improper prescription of controlled substances. Limiting the prescription of controlled substances and recording the number of prescriptions when necessary enables care providers to avoid abuse of their prescription authority and over-prescription and prescribe according to the drug control division guidelines.
References
Chedekel, L. (2015, April 6). High-prescribing nurse surrenders drug licenses. Connecticut
Health I-Team. Retrieved from: http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/.
Preuss, C. V., Kalava, A., & King, K. C. (2019). Prescription of controlled substances:
benefits and risks. In StatPearls [Internet]. StatPearls Publishing.
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- Maylee Perez Soto
Family nurse practitioners prescribe thousands of controlled substances each year all over the country. However, there is a thin line between legitimate and illegitimate prescriptions due to varying reasons, for example, patients have different levels of tolerance to pain, which affects prescription (Preuss, Kalava& King, 2019). This may lead to wrongful prescription, as is the case with one of the top ten prescribing nurses, Heather Alfonso, who prescribed more than 8000 prescriptions for opioids in 2012, and was the highest prescriber in the state of Connecticut (Chedekel, 2015). Among the reasons that warranted the surrender of her licenses to the state was that she prescribed medication without personally examining the patient, but using an unlicensed help to monitor patients. Unfortunately, most health professionals do not know the symptoms of an opioid use disorder. This leads to confusion when presented with opioid dependence and opioid use disorder, ultimately causing wrongful prescription of drugs (Preuss, Kalava& King, 2015). According to Chedekel (2015), the medical boards do not look into prescribers’ actions on the data available unless there are complaints, which increases the chances of mistakes.
To prescribe controlled drugs correctly, prescribers must know the difference between the signs and symptoms of pain and the patients that take these drugs for illegal purposes (Preuss, Kalava&King, 2019). Moreover, all health workers who work with these patients must be licensed and thoroughly trained in prescribing practices that reduce or prevent adverse consequences. The state medical board should also keep tabs on the activities of controlled substance prescribers at all times. Also, prescribers should view their patient’s records in the nation’s database. There should also be initiatives to monitor treatments on long-term treatments, and regulations on pain management clinics should be imposed. There also should be guidelines that practitioners can use in hospitals. Moreover, health professionals in pain management should understand the safety precautions that they should take when prescribing variable doses (Preuss, Kalava& King, 2015).
References
Chedekel, L. (2015, April 6). High-prescribing nurse surrenders drug licenses. Retrieved from https://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/
Dusuegne University. (2020, April 7). APRN’s role in ethical prescribing | Duquesne University. Retrieved from https://onlinenursing.duq.edu/blog/aprns-role-responsibility-ethical-prescribing/
Preuss, C. V., Kalava, A., & King, K. C. (2019, November 16). Prescription of controlled substances: Benefits and risks – StatPearls – NCBI bookshelf. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537318/
- Euclides Munoz Perez
Drug administrators are likely to abuse a prescriptive authority of controlled substances, as demonstrated by the case of an advanced practice registered nurse (APRN) Heather Alonso. She used her position to specify controlled substances under the Medicare drug program. Nurse practitioners have no mandate to prescribe schedule 2 drugs as there is a high potential of them being abused. Such problems come in when nurse practitioners compromise their practice and administer highly controlled substances as opposed to rules and regulations, mainly because of the hefty payment received.
The first step that must be taken to control the administration of controlled drugs is to make sure that a diagnostic workup is conducted (Sun, Charlesworth, Lupulescu-Mann, Young, Kim, Hartung, & McConnell, 2018). The diagnostic workup will make physicians dragonize patients properly before administering any substance. According to Heather Alonso’s case, various patients were never reviewed; therefore, the wrong administration of prescriptions (Chedekel, 2015). The second step that must be carried is to use a prescription database that contains the medical history of the patient. The database will inform the patient whether he or she has received medication from different doctors (Sun et al., 2018). It is also important to screen the drug as it will enable practitioners to establish if the patient honest or he is just misusing drugs.
Documentation is also crucial because the area of prescription needs more extensive and careful documentation of screening questions, examinations, results, and the history of tests to protect the patient (Shore, Yellowlees, Caudill, Johnston, Turvey, Mishkind, &Hilty, 2018). Nurses should use evidence-based decisions when prescribing drugs and also consider the potential of substance abuse as well as the severity of the symptoms. At times, the practitioner is required to write the prescriptions for limited quantities to examine the patient until trust is built frequently. APRN is also crucial as it prevents the diversion if common pitfalls are identified and avoided. Patients who seem to divert drugs need to be intimidated and threatened, and APRNs should never tolerate such behaviors (Shore et al., 2018). Practitioners should always seek support because the practice communicates to patients a serious commitment to safety and, at the same time, acts as a role model to colleagues.
Additionally, countries can improve their prescription drug monitoring programs (PDMP) that will result in advanced standards of monitoring the administration of controlled drugs. All the substances falling under schedule 2-5 are monitored to make these states understand whether surveillance and stricter control is required. Via the PDMP, surprise adults can be carried at the premises of drug administrators to inspect whether the necessary guidelines are being followed. Therefore, improved control and monitoring will be attained when it comes to the administration of controlled substances.
References
Sun, B. C., Charlesworth, C. J., Lupulescu-Mann, N., Young, J. I., Kim, H., Hartung, D. M. … & McConnell, K. J. (2018). Effect of automated prescription drug monitoring program queries on emergency department opioid prescribing. Annals of emergency medicine, 71(3), 337-347.
Shore, J. H., Yellowlees, P., Caudill, R., Johnston, B., Turvey, C., Mishkind, M. … &Hilty, D. (2018). Best practices in videoconferencing-based telemental health April 2018. Telemedicine and e-Health, 24(11), 827-832.
Chedekel, L. (2015). High-prescribing nurse surrenders drug licenses. I-Team In-Depth, retrieved from http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-license
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