Nurse Practitioners and Prescription Drug Abuse

Prescription drug abuse is rapidly increasing.  As a result, advanced nurse practitioners  are finding themselves at the center of professional licensing board, and even criminal, investigations for misprescribing and/or over-prescribing controlled substances.

The Colorado Prescription Drug Monitoring Program requires all prescribing and dispensing of certain controlled substances to be entered into computers.  Nurse practitioners are encouraged to use the database to cross-check concerns about individual patient use or buying patterns.

Despite access to this information through the database, the DEA recently reported that only 10-15% of healthcare practitioners and pharmacists are utilizing this resource in their practice.

Given the growing number of patients abusing prescribed controlled substances and the government’s interest in deterring this abuse, the nurse practitioner should carefully consider the consequences of prescribing controlled substances without first cross-checking their patient’s use and buying patterns of controlled substances.

Read more: Drug registry often ignored despite growing painkiller abuse – The Denver Post http://www.denverpost.com/news/ci_21788638/drug-registry-often-ignored-despite-growing-painkiller-abuse#ixzz29aG5fUQp

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Colorado Professional License Defense Attorney Karen M. McGovern releases new website

An active registered Colorado nurse and former assistant attorney general, Karen McGovern is particularly attuned to the needs of nurses facing professional regulation. She has an in-depth understanding of licensing board procedures and will carefully prepare the strongest case possible on your behalf. Prior to any case proceedings, she will discuss with you the potential outcomes of your legal matter and offer insight into how the board might rule.

Providing insightful, comprehensive defense is always Karen McGovern’s paramount goal. She is well positioned to handle cases involving both state and federal regulatory agencies, as well as those taking place in criminal court. When you retain Karen McGovern, you will never have to feel anxiety over the hassle and expense associated with retaining  two separate attorneys one to defend the criminal charges and another to defend the professional disciplinary action.  Instead, you can feel confident that Karen McGovern will resolve the criminal and disciplinary matters promptly and efficiently.

Visit our new website at www.mcgovernlawoffice.com or www.coloradonursedefender.com and check out the new format. If you find yourself in need of a Colorado Nurse Defender, call The Law Office of Karen M. McGovern, LLC at 303.260.6444 for a free consultation.

Document, Document, Document

On a weekly basis, I speak with a client, or potential client, who explains to me that the Nursing Board complaint against them is unjustified because they did not fail to administer the medication, assess the patient, administer a treatment, call the physician, etc.; they just forgot or didn’t have time to document the action in the patient’s medical record.  And while I have no doubt that the nurse is being truthful in the assertion that the nursing action was completed as ordered, I am forced to explain that the mere failure to adequately document the nursing action in the patient medical record may result in a finding of unprofessional conduct by the State Board of Nursing.

The Colorado Nurse Practice Act defines unprofessional conduct to include negligently failing to make essential entries on patient records. Additionally, the Colorado Nurse Practice Act requires that nurses meet the generally accepted standards of nursing practice, which arguably includes proper documentation.

Nurses are facing increased patient loads, institutional pressure to avoid overtime, and in many cases, computerized medical record systems. Understandably, when stretched thin, the nurse focuses on actual patient care duties, leaving documentation to take a “back-seat.”  This is not only dangerous to the patient, but also the nurse.

Proper documentation protects the nurse when the care and treatment of patient is called into question.  Courts and regulatory agencies often rely on the old adage “If it is not documented, it wasn’t done.”   The nurse is then forced to prove the nursing treatment was administered and the problem is merely inadequate documentation.  In a regulatory setting, this argument still leaves the Board with the option to discipline the nurse for the inadequate documentation.

Nursing liability insurance carriers often post risk management tips for documentation on their websites.  Links to some of the tips posted by Nurses Service Organization are included here.  A few of the tips relate to “paper” charting but can be easily modified for electronic documentation.

This post is intended as informational only and does not constitute legal advice. If you, or someone you know is facing disciplinary action against their nursing license, consult with an experienced Colorado Nurse Defender before making any statements.

The Law Office of Karen M McGovern, LLC, is an experienced law firm specializing in Colorado nursing license defense . Call 303.260.6444 for a free consultation or contact us through our website – www.mcgovernlawoffice.com.

Questioning Orders: Does the Doctor really know best?

As a nurse it is not only your right, but your responsibility, to question any order you believe to be inappropriate.  You have a statutory obligation to advocate for the patient.  In looking out for your patients’ best interests you should never turn a blind eye to a questionable order, assuming that “the doctor or mid-level practitioner knows best.”   Keeping mum in this situation could be viewed as negligence, leaving you vulnerable to disciplinary action against your license or a malpractice claim.

The most glaring situation is when an order could compromise patient safety. This could include an order for a contraindicated drug, or the wrong dosage of a correct drug.  Examples that come to mind are drugs that are contraindicated by patient allergy, laboratory values, or other medications currently being administered to the patient.  Additionally it is not uncommon to receive orders with miscalculated heparin or potassium doses.  As a nurse, you should also be alert for orders that do not meet the generally accepted standards of care or violate a hospital or employer policy or procedure.  You should always question an unclear or illegible order.  If the order is unclear to you, do not guess or assume, get the order clarified by the practitioner who wrote the order.

Questioning a practitioner about his or her orders can be uncomfortable.  However, facing disciplinary action against your nursing license for carrying out an inappropriate order will be downright painful.  When questioning an order, be concise and provide specific reasons for your inquiry, such as a drug label’s indication that the dosage ordered for your patient is dangerous. Be respectful but firm and professional, and don’t back down until you are convinced the order is safe. If the doctor will not change the order, ask for an explanation or solid documentation to support his or her decision. Always thoroughly document your objections, the person with whom you spoke about these objections, and what ensued. If you still are not satisfied, elevate the issue to a charge nurse, the nursing supervisor, or director of nursing.

As a nurse, you should never follow an unsafe order. You are statutorily obligated to protect the patient.  Carrying out a questionable order may compromise patient safety and may leave you to face disciplinary action against your nursing license and/or malpractice claims.

This post is intended as informational only and does not constitute legal advice. If you, or someone you know is facing disciplinary action against their nursing license, consult with an experienced Colorado Nurse Defender before making any statements.

The Law Office of Karen M McGovern, LLC, is an experienced law firm specializing in Colorado nursing license defense . Call 303.260.6444 for a free consultation or contact us through our website – www.mcgovernlawoffice.com.