NANCY J. BRENT MS, RN, JD


A


NPs must know legal obligations when prescribing medications


s a nurse practitioner, you have the authority, based on your state nurse practice act to prescribe medications


for the patients for whom you provide care. For example, states that allow prescriptive authority in some form include Florida, Utah and Pennsylvania. Regardless of the scope of your prescriptive


authority, one overall standard of practice and standard of care is to ensure that any medi- cation you prescribe is compatible with other medications your patient is taking. A 2014 professional negligence case (Huelskamp v. Patients First Health Care, E.D. 100686, Missouri Court of Appeals, Eastern District) emphasizes these standards. Patient S.H. saw a psychiatric nurse practi-


tioner for her depression and was prescribed the antidepressant Lamictal. According to the NP, the patient was informed the medication could cause a rash and if that occurred, the patient was to stop taking the medication and call the nurse practitioner. The patient then began treatment for


high blood pressure with another NP at the same clinic. The family NP reviewed the patient’s medications and saw that she was on Lamictal. On a subsequent visit for body aches,


the family nurse practitioner prescribed the antibiotic Amoxicillin without research- ing the antibiotic and without checking into Lamictal for potential side effects and whether a black box was present that would highlight any safety concerns.


32 Visit us at NURSE.com • 2016 Shortly after this visit, the patient contact-


ed the family NP and complained of a rash, and the family NP agreed to treat her for it. Again, the NP did not delve into Lamictal’s side effects, did not instruct the patient to discontinue the medication, and did not tell the patient to contact the nurse practitioner who prescribed it to determine if she should continue taking the medication. Rather, the family NP told the patient to stop taking the antibiotic and to take Benadryl instead. A second visit took place several days later.


The rash had continued and the family NP prescribed a Medrol Dosepak and told the patient to contact her in two days. No in- vestigation into Lamictal was done and the patient continued taking that medication. The rash became worse so the family NP


suggested the patient see a dermatologist, who instructed the patient to stop the Lam- ictal due to one of its side effects being a rash. The patient stopped the medication. Shortly after the visit with the der-


matologist, the patient was admitted for Stevens-Johnson syndrome which progressed to toxic epidermal necrolysis, involving 98% of her body. The patient filed a medical malpractice


case against Patients First Health Care for the care provided by the family NP, alleging professional negligence, lost wages, sustained pain and suffering, and incurred medical bills. To review the details of the rest of the


case, visit Nurse.com/Article/Brent-NPs. Although not an inclusive list of your legal


obligations when prescribing medications, this case illustrates that you should: 1. Be knowledgeable about any med- ication you prescribe, including side effects;


2. Do a careful assessment about any medications the patient is currently taking, including side effects, black box warnings and dosages;


3. Contact any other prescribers who are working with the patient when there is a question about any untow- ard developments the patient experi- ences after starting any medication, whether it is one you prescribed or one another provider prescribed;


4. Carefully and accurately document your assessments, actions, contacts and instructions to the patient;


5. Remember that you may also face a disciplinary action by your state board of nursing for a violation of your obligations under your state nurse practice act. •


Nancy J. Brent, JD, RN, MS, is Nurse.com’s legal information columnist and attorney in private practice. This article is for educational purposes only and is not to be taken as specific legal or other advice.


TO SEE A FULL LIST of states offering some form of prescription au- thority, visit aanp.org/legisla- tion-regulation/state-legislation/ state-practice-environment.


FOR MORE, visit Nurse.com/Artcle/ Brent-NPs.


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