Chamberlain University College : NR 565 SG Week 2 - Ch1.4.13.25.52_ LATEST UPDATED 2021,100% CORRECT
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Chamberlain University College : NR 565 SG Week 2 - Ch1.4.13.25.52_ LATEST UPDATED 2021
Chapter 1: The Role of the Nurse Practitioner as Prescriber
Roles and Responsibilities of APRN Prescribers
APRN prescriber is responsible for the final decision on which drug to use and how to use it. D...
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Chamberlain University College : NR 565 SG Week 2 - Ch1.4.13.25.52_
LATEST UPDATED 2021
Chapter 1: The Role of the Nurse Practitioner as Prescriber
Roles and Responsibilities of APRN Prescribers
APRN prescriber is responsible for the final decision on which drug to use and how to use it.
Degree of autonomy in this role and the breadth of drugs that can be prescribed vary from state
to state based on the nurse practice act of that state. Nurse practitioner prescriptive authority is
regulated by the State Board of Nursing for each state.
Advanced Knowledge
o Additional knowledge, critical thinking, and assumption of a higher level of legal
responsibility are required to assume the prescriber role
o Knowledge of medicine, pharmacology, and nursing intertwine in the NP role
o As a prescriber, it becomes the role and responsibility of the NP to determine the
diagnosis for which the drug will be ordered, prescribe the appropriate drug,
monitor the expected outcome of the drug, and incorporate a holistic assessment of
the impact of disease and therapy on patient lives
Benefits of an APRN as Prescriber
o Alternative treatment options are also part of the armamentarium that can be used
to treat a given disorder and may interact with the pharmacotherapeutic
intervention
o APRN look at the big picture and consider alternative treatment options and lifestyle
changes
o Patients are looked at in a holistic approach and include the patient in decision
making regarding their care.
o NP practice may thrive under healthcare reform because of the demonstrated
ability of nurse practitioners to control costs and improve patient outcomes
Clinical Judgment in Prescribing
Prescribing drug results from:
o Clinical judgment based on a thorough assessment of the patient and the patient's
environment
o Determination of medical and nursing diagnoses
o A review of potential alternative therapies, and specific knowledge about the
drug chosen and the disease process it is designed to treat
o NPs factoring in the cost to the patient of the medication prescribed
Is there a clear indication for drug therapy?
o In the age of health-care reform and increased awareness of the limitations of
drugs, whether a medication is the best option for treatment has become an
important question.
What drugs are effective in treating this disorder?
, )
o Several drugs may be effective in treating a condition, so which one is best
for a particular patient?
Even if only the most effective class of drug is considered, few classes of
drugs include only one drug
o How does one determine “best”; what are the criteria? Are there nationally
recognized guidelines that can be used?
The Agency for Health Care Quality (AHCQ), the National Institutes of
Health (NIH), and many specialty organizations publish disease-specific
treatment guidelines that include both pharmacological and
nonpharmacological therapies
Consult nationally recognized guidelines for disease management
What is the goal of therapy with this drug?
o What is the best drug to achieve treatment goals?
, )
Various goals are possible in the choosing of therapy
Under what conditions is it determined that a drug is not meeting the goal and a
different therapy or drug should be tried?
o At the onset of therapy, the provider and patient should have a clear
understanding of what outcome or goal is expected of the medication
prescribed
o Follow-up and monitoring times are established to see how well treatment
with the drug is meeting the goal
Are there unnecessary duplications with other drugs that the patient is already
taking?
o The patient’s medication history should be reviewed at each encounter to detect
duplications or medications that may be discontinued
Would an OTC drug can be just as useful as a prescription drug?
o Increasing numbers of drugs are being moved from prescription to over-the-counter
(OTC) status
What about cost?
o Who will pay for this drug? Can the patient afford it? Will the cost of the
medication affect adherence to the treatment regimen?
Cost is an issue for several reasons
Many insurance policies do not cover the cost of drugs or only
provide partial coverage, so the patient must pay “out of pocket”
The newer the drug, the more likely the cost is too high based
on the drug manufacturer’s need to reclaim research and
development costs while the corporation still holds the patent
on that drug
Newest is not always best, and condition of cost is a major factor in
choosing between newer drugs and ones that have been around long
enough to be available in generic form
Many insurance plans have larger copays for name-brand drugs than
for generic medications
Multiple national retail pharmacies have developed $4 prescription
formularies
Awareness of what is on the local discount formulary may save
the patient hundreds of dollars in prescription costs and may
increase compliance
Factors likely to lead to poor adherence include a drug that is
expensive in relation to a patient's finances, a drug that must be
taken daily as part of a complex regimen, and a drug that is not
covered by insurance.
Where is the information to answer these questions?
o Wide array of professional literature that ranges from the well-reputed journals to
literature from specialty and professional organizations, the multitude of
computerized drug databases
Collaboration with Other Providers
, )
Collaborate with physicians, pharmacists, podiatrists, mental health specialists, therapists, and
other providers, including APRNs who are not NPs, physician assistants (PAs), and other
nurses.
Physicians
o Early in the development of the NP role, physicians were the teachers in the NP
programs and accepted NPs as physician-extenders
Pharmacists
o Profession of pharmacy requires graduate-level preparation for all pharmacists
with the granting of a practice doctorate, the Doctor of Pharmacy (PharmD)
o A PharmD can assist by offering expertise on the clinical management of
patients, including available dosage forms, potential adverse reactions, and
drug interactions
Other APRNs
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