Adult Primary Care Prescription Refill Guidelines for Ambulatory

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Adult Primary Care Prescription Refill Guidelines for Ambulatory Services • •

• •

The goal is to complete/reply to refill requests within 48 hours or receipt, regardless of the form of the request, i.e. fax, phone or pharmacy. If there is a discrepancy between the patient’s desires and the refill policy, o The Access Center or clinic nurse is to create an encounter and forward to the PCP or the PCP’s nursing pool. o Clinic nursing staff will work with the PCP or physician on duty to resolve the discrepancy and refill the medication accordingly. Physicians are to address all Patient Call messages as a priority of Epic In-basket management each day. If PCP is not available, urgent refill requests should be directed to the faculty on duty.

REFILLS TO BE PROVIDED BY THE ACCESS CENTER OR NURSING STAFF • Antihypertensive medications • Diabetes medications • Cardiac medications • Hormonal medications • Thyroid medications • Headache medications • Antidepressant (non-controlled substances) medications • Gastritis or GERD medications • Seizure medications Request # Supply may Rx Refills Comments 1st request 30 days 0 make appointment w/in 30 days nd 15 days 0 make appointment w/in 15 days 2 request 3rd request 7 days 0 make appointment w/in 7 days Medications can be refilled via phone or fax to the patient’s pharmacy of choice, using the PCP as the authorizing provider. Please verify the PCP by chart review. * Clinic nursing staff will work with the PCP to see when additional refills are appropriate* REFILLS TO BE PROVIDED BY PCP OR PHYSICIAN ON DUTY • Controlled substances (anxiolytic, muscle relaxant, narcotic or sleeping aid) Includes triplicate prescriptions • Antibiotic medications • Anti-fungal medications • Anti-viral medications • Anti-emetic medications ADDITIONAL PRESCRIPTION POLICY PROCEDURES: • Mail off prescription request is to be authorized by the PCP or partner, therefore send requests through the Epic encounter refill request. • Clinic nurse assigned to refill prescriptions is to check Epic prescription pool messages very 2 hours at minimum. • Clinic nurse will notify the patient when the controlled medication refills have been authorized.



Hormone Replacement Therapy (HRT) & Over the Counter Prescriptions (OCP) may be filled for up to 13 months after last Well Women Exam. REFILL PRESCRIPTION NURSE IS TO DOCUMENT IN EPIC ENCOUNTER: • The next scheduled appointment date and time. • The date of the last office visit and date of last prescription written for requested medication. • The date of the last well women exam for HRT or OCP requests. • The date and level of last TSH for thyroid medication requests. • The date and level of last digoxin level for digoxin refill request. • The date and level of last phenytoin level for phenytoin refill request. • The date and level of last carbamazepine level for carbamazepine refill request. • The date and level of last valporic acid level for valporic acid refill request.

Pediatric Primary Care Prescription Refill Guidelines for Ambulatory Services 1. Urgent Medications: • Antiepileptic • Antihypertensive • Asthma medications (no oral steroids, provider must be called for those) • Diabetes Request # Supply may Rx Refills Comments st 1 request 30 days make appointment 2nd request 15 days make appointment rd 3 request 7 days make appointment none make appointment 4th request 2. Non-Urgent Medications: • Acne medications • Allergy medications • Contraceptives • Headache/Migraine medications (no narcotics) • GERD medications • Thyroid medications • Atopic dermatitis medications (topical steroids, etc) Request # 1st request 2nd request

Supply may Rx 30 days none

Refills

3. Non-Urgent Medications, provider Approval Only: • Antibiotics • Anti-emetic medications • Anti-fungal medications • Behavioral medications including antidepressants, etc • Cold/cough products • Pain medications • Oral Steroid medication *****Provider must be called for refills.

Comments make appointment make appointment

Cardiology Prescription Refill Guidelines for Ambulatory Services • • • •





All requests for cardiac medication refills are to be documented in the EPIC encounter. The nurse will refill the patient medications as indicated in the EPIC encounter within 48 hours of receipt. Controlled substances will not be filled and the patient will be referred to their Primary Care Provider (PCP). Before refilling the request on EPIC encounter, the nurse must confirm: o The patient is a Cardiology patient and on EPIC. o The patient was seen within 6 months of the phone call. If the patient has an appointment with one of the Cardiology faculty within 2 weeks, the nurse can give enough medication to last until the appointment. o Occasionally, patients are instructed to return to clinic in a year. In this case, the nurse may refill the medications as long as the patient was seen within 12 months of the phone call. o The patient does not verbalize any new concerns, signs or symptoms. o The patient has not had any major medical illnesses since the time of the last visit. o The requested medication is on his/her EPIC medication list. When the above is achieved, the nurse can refill the request. All other refill requests shall be forwarded to the physicians for authorization.

UTMB Family Medicine Clinic IHOP policy C51- Prescription refill management guidelines for ambulatory services. Policy for clinical nursing staff and access center Refill request(s) will be addressed within 48 hours.   

Discrepancies concerning refill(s) can be addressed with the prescribing physician or faculty on duty (GT). Urgent requests can be directed to the faculty on duty. Time Sensitive calls and messages not addressed by physician in EPIC within 48 hours will be redirected to GT on duty.

Requirements for refilling prescriptions    

Medication was originally prescribed by this office in the last 12 months. Patient’s visit over 12 months may have 30 day supply without refills. Appropriate labs were done within the last year. If labs greater than 1 year, 30 day supply without refills. Diagnosis for this medication was addressed during prior visits.

Medication

Labs/info needed

Refill approved

BMP (Normal K+)

90 days + 1 refill

LFT

90 days + 1 refill

Cardiac (digoxin, isordil)

Digoxin level, BMP

90 days + 1 refill

Diabetic (metformin, insulin, glipizide, Actos)

BMP (Normal Cr), A1C

Hypertension (Lisinopril, propranolol, HCTZ) Cholesterol (statins)

Thyroid (armour, synthroid) BPH (Flomax, proscar) Bisphosphonate (Fosamax, Actonel) OCP/HRT GERD, Ulcers (Pantoprazole, nexium, Pepcid, ranitidine) Asthma/COPD/inhalers (advair, ventolin, atrovent) Depression (Zoloft, paxil, wellbutrin) NSAIDs (naproxen, ibuprofen) Seizure (Dilantin, valproate, keppra) Migraine (imitrex, maxalt, zomig) Antibiotics Antifungals Anxiolytics Muscle relaxants Narcotics / opioids Sleeping aids Anti-Coagulation

TSH

90 days + 1 refill 90 days + 1 refill

PSA

90 days + 1 refill

BMP

90 days + 1 refill

WWE, mammogram

90 days + 1 refill

No worsening of symptoms

90 days + 1 refill

No worsening of symptoms, no >than 1 inhaler per month No change in dose in last 3 months BMP (WNL Cr) Levels WNL in last 3 months

90 days + 1 refill 90 days + 1 refill 30 days + 0 refills 30 days + 0 refills 30 days + 0 refills

None

Send message to prescribing physician or PCP

Await instructions from Physician

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Adult Primary Care Prescription Refill Guidelines for Ambulatory

Adult Primary Care Prescription Refill Guidelines for Ambulatory Services • • • • The goal is to complete/reply to refill requests within 48 hours o...

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