Attendees
- Becky gradl
- Stephen Chu
- Jay Lyle
- Mike Padula
- Emma Jones
- Leslie Rauth
- Chris Melo
- Shelly Spiro
Topic: Prescription vs order - Facilitated by Becky Gradl.
Discussion:
Prescription Definition - an instruction written by a medical practitioner that authorizes a patient to be provided a medicine or treatment
- Instruction written by a practitioner authoring a patient to do something
- Prescription is a sub-type of order. Is not limited to only prescribing medications.
Stephen: Providers can prescribe a management plan. Is prescription limited to a medical practitioner?
Mike P – can prescribe PT or other things in a similar manner by someone with a certain level of licensure. Prescription is different from orders in that orders are typically something someone will execute.
Emma - Prescribing Clinicians – for nurses with appropriate licensure
Becky - Nutrition looks at prescriptions as happening before the order. The order is the overarching action, and will contain or generate a more specific action like a prescription or a referral
Stephen - Components in the concepts of orders and prescription
- Prescription is generated
- order for the medication to be dispensed
- Order for the medication to be administered
Becky - Inpatient gets an order and the order flows thru the workflow.
general agreement that Prescriptions are largely an outpatient thing. Outpatient side uses prescription, Orders are used on the inpatient side.
Inpatient Medication orders are used
Stephen - Outpatient prescribes – PT, DME, Eyeglasses, Testing supplies; not limited to medications
Jay - What leads to ordering?
Becky - Outpatient – to see a dietician, not in private practice, needs a physician referral; Inpatient – have to have physician order. M’care covers certain things. When patient comes into inpatient protocols and policies initiate the process.
Physician order for TPN – include a prescription as part of the Dietician workflow. In this case it’s a “prescription”. Oral diet or enteral nutrition depends on the state and if the dietician have ordering rights.
MCC was looking at how to provide information to a patient with chronic kidney disease – nutrition order looked more inpatient. Wanted to provide nutrition “instructions” – can they use nutrition order to represent it? Again the Prescription Vs Order question. Nutrition DAM specific to nutrition order. Recommendation to come up with a nutrition prescription which will lead to the nutrition order. Order is broader but prescription is what is needed.
Shelly Spiro - it comes down to regulation. What terms you use in your system/EHR is up to you. When its shared outside your system then you have to follow the regulation. Comes down to Terminology – try to be consistent as possible. Need to be consistent with what you use internally but define the terms used. Pharmacy uses the term prescription to mean something that have legal meaning.
Links about the regulation – look at NABP - National association of the state board of pharmacies. Instead of going state by state, use NABP as a source.
Becky - Next steps – need to look at our business terminology. Nutrition order for ordering system; Nutrition Instructions need to be done
Stephen - will bring this up with the Pharmacy work group. Will attend their call on monday.
Becky - had discussions with John Hatem. New resources to consider for nutrition intake.
Emma - Encourage collaboration with PCWG on nutrition instructions. PCWG need to further investigate patient instructions and if FHIR