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National Provider Identifier (NPI) - A National Provider Identifier is a unique 10-digit identification number issued to health care providers (physician, physician assistants, nurse practitioners, dentists, etc.) by the Centers for Medicare and Medicaid Services (CMS). Prescription intake, which is often the responsibility of a pharmacy technician, involves both the receipt of the initial prescription and, in a community pharmacy setting, gathering pertinent patient data.
With respect to prescription intake the first thing to address is the means by which the medication itself arrives in the pharmacy. When a community pharmacy receives a prescription it is a requirement to note the source of the prescription if it is for a Medicare or Medicaid patient.
The Medicaid Tamper-Resistant Prescription Pad Law has placed additional requirements on written prescriptions to help ensure the legitimacy of the prescriptions being received in the pharmacy. Category One - One or More industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form. Category Two - One or More industry-recognized features designed to prevent the erasure or modification of information written on a prescription by the prescriber. Category Three - One or More industry-recognized features designed to prevent the use of counterfeit prescription forms.
Physicians may, and often do, use these tamper-resistant prescriptions for their other patients as well. DEA has granted three exceptions to the fax prescription requirements for Schedule II controlled substances.
A practitioner prescribing Schedule II narcotic controlled substances to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion may transmit the prescription by fax.
Practitioners prescribing Schedule II controlled substances for residents of Long Term Care Facilities (LTCF) may transmit a prescription by fax to the dispensing pharmacy. A phone order prescription (also called a verbal order), should include all the same information as a written prescription as the pharmacist will need to reduce it to writing to later be filed with the other prescriptions. For Schedule II controlled substances, an oral order is only permitted in an emergency situation. Immediate administration of the controlled substance is necessary for the proper treatment of the patient.
Provision of a written prescription to the pharmacist prior to dispensing is not reasonably possible for the prescribing physician.
In an emergency, a practitioner may call-in a prescription for a Schedule II controlled substance by telephone to the pharmacy, and the pharmacist may dispense the prescription provided that the quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period. Through the requirement of using computer programs that communicate through SureScripts to electronically prescribe outpatient prescriptions, SureScripts has the responsibility of authenticating both the receipt and delivery of the electronic prescription. Prescribers are required to provide a two tier authentication of prescriptions for controlled substance. Institutional settings are more likely to utilize CPOE (computerized prescriber order entry, also called computerized physician order entry) than e-prescribing. In an inpatient setting, while a pharmacy will still want all this information to be completed, it is typically the responsibility of other departments. Once the prescription has entered the pharmacy, it becomes the responsibility of the pharmacy staff to decipher and fill the medication for the patient. Prescriptions have been obfuscated by a combination of Latin and English abbreviations (sometimes they even throw in Greek words). Traditionally, a prescription is a written order for compounding, dispensing, and administering drugs to a specific client or patient and once it is signed by the physician it becomes a legal document. Patient Information, which may include information such as name, address, age, weight, height, and allergies. Signature lines, which is where the prescriber provides their signature and indicates their degree.
Prescriber information, which includes the physician's name, practice location address, telephone number and fax number.
Refills, which simply indicates how many refills may be supplied for a particular medication. Warnings, which are provided by the prescriber with the intention of emphasizing specific concerns.
So, if we look at a prescription for Patricia Pearson (see below), we can see that it is for Lipitor (atorvastatin Ca) 20 mg tablets, and that the patient is to receive 30 of them with 2 refills.
Other things of note include the date that the prescription is written for is August 31, 2013. Besides over the counter medications (OTC) such as aspirin and ibuprofen, behind the counter medications (BTC) such as Allegra-D (fexofenadine with pseudoephedrine), and prescription medications (Rx legend) such as amoxicillin and digoxin, there is another group of medications to be concerned with called controlled substances.
Various calculations involved in correctly interpreting prescriptions frequently need to be performed to account for days' supply, adjusting refills and short-fills. Physicians often just include a quantity of medication to dispense and directions on how frequently to use it. The first things to look at are tablets, capsules, and liquid medications because they're the most common and the most straight-forward to perform calculations with.
The item to be careful about when it comes to tablets, capsules, and liquid medications are PRN medications, especially ones with variable doses and variable frequencies. Whenever you see instructions on a product for a patient to receive a particular number of sprays or puffs of a given drug, you should stop and actually look at the packaging to discover how many metered inhalations or how many metered sprays are actually in the container.
Calculations for creams and ointments are a little more tricky because you usually don't know exactly how much will be used in a dose. Only 500 mg per dose is used in the calculation because the prescription specifically requested for it to be applied sparingly. To solve this type of problem, you need to know a conversion factor from milliliters to drops. Another odd thing to keep track of when dealing with eye preparations are ophthalmic ointments.
Many medications (such as birth control, steroids, and antibiotics) may come in packs with very explicit instructions for use. Example: A prescription is written for methylprednisolone 4 mg tabs taper pack use as directed.
1st Day: Take 2 tablets before breakfast, 1 tablet after lunch and after supper, and 2 tablets at bedtime.
2nd Day: Take 1 tablet before breakfast, 1 tablet after lunch and after supper, and 2 tablets at bedtime.
3rd Day: Take 1 tablet before breakfast and 1 tablet after lunch, after supper, and at bedtime.
Unfortunately, there are many medications that have their own specific rules, such as estrogens given for hormone replacement therapy that are cycled on and off.
The amount of medication a pharmacy can dispense to a patient is restricted first, by the prescriber's guidelines and second by the insurer's guidelines. Then, using dimensional analysis we can figure out how many capsules will be needed for each fill.
Next, using dimensional analysis we can figure out how many fills from the insurer will be required to dispense the quantity written for by the physician. Therefore, there will be 5 refills after the initial fill is dispensed, but there is still a partial fill left. Now, based on the information we have already determined, we will figure out how many capsules to dispense for the partial fill. Once the information on a particular prescription has been accurately interpreted, it will need to be entered into the pharmacy software management system. In order to process the prescription, it will need to be entered into a pharmacy management software system. When comparing systems, the first thing you'll notice about pharmacy software is that some programs have chosen very different user interface paradigms. Text-based user interfaces have the advantages that they can usually be run on older hardware successfully and don't require as much network bandwidth.
GUIs have the advantage that they are primarily point and click software relying largely on mouse usage along with keyboard input for text boxes (some GUIs are looking at possible transitions to incorporating touch interfaces). Speed Script software demonstrating its ability to show pill imagesSome companies attempt to create software that can bridge the gap between these two paradigms. A major challenge to any pharmacy when choosing a pharmacy management system is pricing along with per-seat licensing, types of tech support and maintenance, local servers versus remote hosting, accessing systems with a local client compared to a web browser compared to virtualization, the types of back-up services available, potential concerns over vendor lock-in, etc. Pharmacy staff will need to enter information into the pharmacy software management system in order to process the prescription. Prescriber information -This typically includes the prescriber's name, address of practice, contact information, medical license number, DEA number, and National Provider Identifier (NPI).
Third-party payor - This includes coverage type (primary, secondary, etc.), insurance name and bank identification number (BIN), group number, and member number. Patient information - The patient information should at least include name, date of birth, address, contact information, allergies, and payment type (cash vs. Prescription information - While many items on a prescription are important the system should record as a minimum the date the prescription was written, superscription, inscription, subscription, signatura, refills, prescription origin code, and it should generate a unique prescription number that should appear on the prescription label as well. Drug information - At a minimum, drug information should include the drug name, the medication's National Drug Code (NDC), the manufacturer, and an ability to check for interactions and contraindications. Even though it is not required on the federal level, most prescription labels will also include the medication name, strength, and dosage form. When it comes to packaging a product before it leaves the pharmacy, the prescription label is only one part of that. If a medication is dispensed without a child safety cap, most pharmacies will note it in their pharmacy management software and often include an explanation as to why. The majority of medications are safe to store at controlled room temperature, 15° to 30° C or 59° to 86° F. Various plastics, including polyvinyl chloride (PVC) have been used in heath care for over 50 years as it is an affordable and tear resistant product that can be manipulated to achieve varying degrees of flexibility versus rigidity. There are several means that may be utilized to provide proper product validation including the use of NDCs, barcode scanning technology, and a final visual verification. Once the medication has been filled and checked it is ready for the patient to pick it up which usually involves any payments (including copays), the offering of medication counseling, and the proper recording and filing of dispensed prescriptions. In a community pharmacy setting a patient (or their family member, caregiver, or other authorized individual) may go to the prescription pick-up counter to receive their medication. Also, while not a requirement, a common pharmacy practice is to stamp their Schedule-II medication with an 'N' stamp to denote it as a narcotic and make it easily identifiable from other prescriptions.
Pharmacy Times, A Review of Federal Legislation Affecting Pharmacy Practice, Virgil Van Dusen , RPh, JD and Alan R.
Prescriber – Provider, Fellow, Resident, Nurse Practitioner, or Physician Assistant Service Level – The level of e-prescribing capabilities a Prescriber or Pharmacy has. Synchronous Error – Real-time error response from SureScripts indicating that the e-Prescription was not received by the intended recipient, pharmacy or prescriber.
The Problem: MyRx seeks to solve the problem that pharmacists and doctors experience when there is a lack of easy, instant, paperless communication between.
State of Kansas INF50 Excel Voucher Upload Statewide Management, Accounting and Reporting Tool The following Desk Aid instructs users on overall functionality. Confidential 1 Electronic Prescribing of Controlled Substances (EPCS) Part 1 of a 3 Part Series Chuck Klein, Ph.D. SYSTEM PLANNING Addendum FALL 2003 RFP Detailed Instructions for Bidder Registration and Proposal Submission ENTERGY SERVICES, INC. KePRO’s Service Authorization Process Outpatient Rehabilitation Services INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT Outpatient Rehab.
Service Authorization for Alzheimer's Assisted Living Waiver (Service Type 0980) Presented by: KePRO INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT.
0 eCPIC Training: ITDB Monthly Validations Quick Guide These training materials are owned by the Federal Government.
MyRx seeks to solve the problem that pharmacists and doctors experience when there is a lack of easy, instant, paperless communication between the two. Divisional Title BTEC Approval, Registration and Certification September 2008 – Examination Officer Training. 1 Centers for Medicare & Medicaid Services 2008 Physician Quality Reporting Initiative (PQRI) September 18, 2008 National Provider Call.
If you are a subscriber to the JCSM (including members of the AASM), please login to access the journal. POCs are now mandatory for both Medicare and Medicaid patients and many other insurance companies require this as well. E-prescribing allows a physician, nurse practitioner, or physician assistant to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. Also in the inscription you find the dose and dosage form, such as tablet, suspension, capsule, syrup.
An NPI is a required identifier for Medicare services, and is also used by other payors, including commercial healthcare insurers.

No actual bank is involved in this part of the process, the name is a hold over from early electronic banking jargon. A DAW code of '0' applies to most prescriptions as they allow for generic substitution and patients are generally willing to receive the more affordable version. Prescriptions may arrive on a traditional prescription form (there are specific security requirements on this if the patient is using Medicaid), a fax or phone call from an appropriately licensed prescriber, e-prescribing in an outpatient setting, and computerized prescriber order entry (CPOE) in an institutional setting. As many individual insurance companies also require this information it has become a common practice for community pharmacies to track where all prescriptions come from. Since October 1, 2008 all Medicaid scripts must contain one or more industry recognized features from each of three categories of security as specified by the Center for Medicare and Medicaid Service (CMS).
The same requirements listed on written prescriptions apply for faxed prescriptions (although prescribers do not need to use tamper-resistant prescription pads for faxed orders), but their is an additional limitation.
The pharmacy will consider the faxed prescription a "written prescription" and no further prescription verification is required. The prescribing practitioner must provide a written and signed prescription to the pharmacist within seven days. For this two tier authentication, the DEA is allowing prescribers the use of any two of the following – something you know (a knowledge factor), something you have (a hard token stored separately from the computer being accessed), and something you are (biometric information). CPOE is a process of electronic entry of practitioner instructions for the treatment of patients under their care.
This will likely require the translation of various medical abbreviations and some calculation to ensure that the proper quantity is being dispensed. They are commonly used on prescriptions to communicate essential information on formulations, preparation, dosage regimens, and administration of the medication. Use context clues from the rest of the prescription to determine which translation is appropriate.
Prescriptions are required for all medications that require the supervision of a physician, those that must be controlled because they are addictive and carry the potential of being abused, and those that could cause health threats from side effects if taken incorrectly, for example, cardiac medications, controlled substances, and antibiotics. Often, this is also where a prescriber may indicate their preferences with regard to generic substitution.
Prescribers often just include a quantity of medication to dispense and directions on how frequently to use it. Often it is not as simple as giving a tablet once a day for 30 days; you will frequently need to do calculations for oral liquid medications, injectables, nasal sprays, and inhalers, and make estimations for PRN's, ointments and creams, lotions, eye and ear drops, and ophthalmic ointments. In general, you should perform the calculations using the shortest interval with the highest dose. Sometimes your calculations will come out to a decimal number of days and you may need to use some professional judgement to determine whether to drop the decimal or round up. Lets look at an example problem accompanied by some of the text from the front of the container.
The amount will depend on how large of an area is affected and how many areas it needs to be applied to.
Unfortunately (or fortunately since most students despise the apothecary system), you cannot use the conversion from the apothecary system. The standard expectation is for the patient to sleep 8 hours per day and therefor be awake for 16 hours a day. These instructions often explain exactly how many days they will last and require no additional calculations.
The cycle is days 1-25 on, followed by five days off or it may be cycled for three weeks on, followed by one week off. As previously mentioned in this chapter, when prescribers write these prescriptions they may have various time frames in mind which sometimes differ from the period of time required by a specific prescription benefits manager.
To cover this we should look at what pharmacy software management systems entail and what kind of information will need to be entered to process the prescription. Pharmacy management software systems are not standardized in appearance, which allows companies to compete with each other to try and implement their own vision as to how an integrated environment should look and feel for the end users.
For most programs there are two types of interfaces: text-based user interfaces (somewhat reminiscent of DOS style programs in appearance) or GUI (pronounced goo-ey and stands for graphical user interface). This kind of software may be installed locally or remotely depending on the offerings from the manufacturer and software's specific design. Most prescriptions allow for generic substitution and patients are glad to receive the more affordable version, therefore the default DAW code is typically set to '0'.
Often this drug information will include information on auxiliary labels, specific lot numbers and expiration dates, stock availability, pricing, and medication guides.
The most common exceptions are if the patient or physician requests that the patient not receive child safety caps, or for emergency sublingual medications commonly used in response to angina. Failure to comply with the PPPA could result in the pharmacist being prosecuted and imprisoned for not more than 1 year or sentenced to pay a fine of not more than $1000, or both.
Some medications may require refrigeration, 2° to 8° C or 36° to 46° F, or they may even need to be frozen, -25° to -10° C or -13° to 14° F, after they are dispensed (these temperature ranges have been established by the United States Pharmacopeia Convention). For most products this is an ideal packaging material, however some medications either contain or function as plasticizers which cause them to bind to the PVC and also change the fluidity of the PVC container itself. Traditionally, prescribers will include an order for the patient's syringes and needles; although, the pharmacy staff may still need to determine the most appropriate syringes to dispense.
The pharmacy management software will have recorded a specific NDC for the medication that is being dispensed. As some patients may have the same or similar names, many pharmacies require the answer to a simple question to ensure that the medication is for the individual at the counter. Prescriptions will be deemed readily retrievable if, at the time they are initially filed, the face of the prescription is stamped in red ink in the lower right corner with the letter "C" no less than 1 inch high and filed either in the prescription file for controlled substances listed in Schedules I and II or in the usual consecutively numbered prescription file for noncontrolled substances.
The computers on which the records are maintained may be located at another location, but the records must be readily retrievable at the registered location if requested by the Administration or other law enforcement agent. Prescriber – Provider, Fellow, Resident, Nurse Practitioner, or Physician Assistant Service Level – The level of e-prescribing. SPI – SureScripts Prescriber ID (think of this as SureScripts’ version of a Prescriber’s NPI (National Provider ID). E-Prescribe (or e-prescribing) – Computer-based transmission of a prescription between a prescriber and a pharmacy. Asynchronous Error – Delayed error response from SureScripts indicating that the e-Prescription was not received by the intended recipient, pharmacy or prescriber. To register a prescriber, we need the following information: Prescriber Name Prescriber Identifications Clinic Name Clinic Address Clinic Phone Number Clinic Fax Number The prescriber must also be credentialed and active within the VISTAR (Providers, NPs, PAs, and Fellows) or GME (Residents and Fellows) database. The Workers Comp Help Desk is designed to provide the highest level of convenience and support for Industrial Carrier Professionals. Department of Justice Drug Enforcement Administration Office of Diversion Control Electronic Prescriptions for Controlled Substances June 1, 2010.
VCSS Registration Overview ? VCSS Account Registration is the process you complete in order to register. Please note: access to the article is from the computer on which the article is purchased ONLY. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders.
If a physician requires a specific medication to be dispensed, they will typically note this on the prescription. These various means have various federal regulations associated with them and individual states may place additional restrictions on how they are used. These prescriptions are tracked using prescription origin codes (POC) which are commonly entered into the pharmacy management software. As of June 1, 2010 physicians and pharmacies are also allowed to transmit prescriptions for Schedule II, III, IV, and V medications. The hard token, if used, must be a cryptographic device or a one-time password device that meets the Federal Information Processing Standard 140-2 Security Level 1. These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. There are approximately 20,000 medical abbreviations; instead of providing an exhaustive and meaningless list, this section will focus on the most common medical abbreviations that are necessary for interpreting prescriptions and performing calculations.
The format on these lists will be to provide the abbreviation, followed by its intended meaning.
Pearson will need a new script if she still needs this medication past August 31, 2014, regardless of how many refills were written for.
There are 5 schedules of controlled substances with various prescribing guidelines based on abuse potential, as determined by the Drug Enforcement Administration and individual state legislative branches.
This will provide the shortest span of time in which they could use all the medication dispensed. A 10 mL vial of U-100 strength insulin would contain 1000 units and a 15 mL box of syringes with U-100 insulin would contain 1500 units.
The amount applied usually does not exceed 500 mg to 1 g, so unless you know otherwise, use 1 gram for the dose for each affected area. The USP in chapter 1101 has written guidelines on the standardization of medicine droppers. Items like a vial of nitroglycerin sublingual tablets or spray are expected to last a patient 30 days.
Calculations are often needed to first adjust the quantity dispensed to comply with the insurer's guidelines, and then the number of refills allowed.
Most of these programs have been around a long time so they tend to be very mature and have relatively few software bugs. These systems will typically require more overhead when compared to text-based user interfaces but staff often finds them less intimidating. Often, pharmacies will request information on concurrent use of other medications and dietary supplements, preferences with respect to safety lids, verification that the patient has received notification of the pharmacy's privacy policy. With this in mind, we need to consider whether or not the packaging provides adequate light resistance, temperature for long term and short term storage, as some products will react to some plastics you need to consider PVC vs glass containers, child safety lids are concern to protect unintentional poisonings but this needs to be balanced by sufficient ease of use for the patient, some products will require syringes (either oral or injectable) and a degree of knowledge about the intended dosage and dosage route of the medication will help with this decision.
As an example, when nitroprusside is exposed to direct sun light it will breakdown into cyanide.
If the patient is picking them up from a community pharmacy, the pharmacy staff should inform the patient if special storage requirements are needed.
These medications need to be stored or manipulated with products that they will not react to.
They are simple to use and provide a safety factor that needles can not easily be attached to them ensuring that the patient does not receive them as an injection.
In most states, patients may also request syringes without a prescription, but they may have difficulty getting a third-party payor to cover them.
It is a good practice to check the NDC in the computer against the product being dispensed to ensure both accuracy and to avoid any kind of billing fraud. Common questions include asking for their birthday or the last four digits of their social security number, which the technician can verify in the pharmacy software.
Title 21 of the Code of Federal Regulations - Section 1304.04 Maintenance of records and inventories - Subsection h, you will find the prescription filing options that are considered acceptable on the federal level, some states may place additional requirements on this process. However, if a pharmacy employs a computer application for prescriptions that permits identification by prescription number and retrieval of original documents by prescriber name, patient's name, drug dispensed, and date filled, then the requirement to mark the hard copy prescription with a red "C" is waived.
The electronic application must be capable of printing out or transferring the records in a format that is readily understandable to an Administration or other law enforcement agent at the registered location. NewRx – Prescriptions e-prescribed from RxStar (This does not have any association with VUMC’s Renewal prescription policy.). Purchase of the article does not permit distribution, electronic or otherwise, of the article without the written permission of the AASM.
While this is a recent shift in federal law, some states may still prohibit e-prescribing for controlled substances. Some states may specify which tiers they specifically require for prescribing controlled substances. CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at the point of care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges.
While amongst health care professionals we would use the phrase sublingual as a route of administration, it may be necessary to translate 'SL' as 'under the tongue' for many patients. When prescribers write these prescriptions they may have various time frames in mind which sometimes differ from the period of time required by a specific prescription benefits manager. This is good information to help you make quick work of the vast majority of insulin calculations. Unless your specific medication notes something different, a dropper should be calibrated by the manufacturer to deliver between 18 and 22 drops per milliliter. With items, like vaginal preparations, you'll need to know how much is delivered via the applicator.
You'll find that most pharmacies have chosen different systems, but no matter what they look like they need to manipulate the same data.

The down side is that newer employees tend to be intimidated by text-based user interfaces as they have grown accustomed to GUI interfaces in most of their interactions with software.
Then you will fill it with the appropriate medication, package it properly, and validate that everything has been done correctly. Some common light sensitive medications include acetazolamide, doxycycline, linezolid, and zolmitriptan.
If these medications are being dispensed by either a delivery service or a mail order pharmacy extra steps may need to be taken to help ensure that the products are maintained within proper temperature ranges, such as using cold containers with ice packs. Many pharmacy management systems also include barcode scanning to provide another double check that the NDC on the bottle matches the NDC in the computer (the barcode on the manufacturer's bottle contains the NDC).
Electronic copies of prescription records must be sortable by prescriber name, patient name, drug dispensed, and date filled. It is an VUMC internal reference number that represents a single prescription, which identifies the prescription, patient, provider, etc.
E-Renewal Request – A prescription request sent from a pharmacy to a provider with the intent of renewing the prescription. Further, purchase does not permit the posting of article text on an online forum or website. Sometimes a patient may request that they receive a brand name product even if a prescriber allowed for generic substitution.
The last significant item on this label is that the physician did not include their DEA number. With insulin problems, whenever you come out with a decimal number of days you should always just drop the decimal as you never want a diabetic patient to run out of their insulin.
How many capsules can be dispensed using the insurance plan guidelines and how many refills are allowed with the adjusted quantity? While many drugs need to be protected from light while in storage, their original package from the manufacturer should suffice. In situations where plastics are still desirable the plastics will need to be manipulated to prevent the medications from functioning as a plasticizer by either a coating the surfaces of the container or a chemical change throughout the whole structure of the container. Conveniently, many pharmacy software management systems are able to offer point of sale capabilities as well.
SureScripts Message ID – It is an external reference number used to track the e-Prescription.
E-Renewal Response – The prescriber’s response to the pharmacy’s e-Renewal Request (accepted, denied, etc.). The last thing to keep in mind with respect to an insulin vial is that it should not be kept for longer than 30 days after it has been opened. A good rule of thumb for a lotion is to expect 2 mL to be used on each affected area per application. If you need to repackage any medications, always be sure to consult the manufacturers recommendations to determine if you need to place the medication in light resistant packaging or not. Nitroglycerin is a common example of this where the sublingual form and injectable forms both need to avoid prolonged exposure to traditional PVC containers. Traditionally this is the pharmacist that provides this role, but in some states pharmacy technicians under specific conditions are allowed to perform tech check tech.
The technician also needs to offer medication counseling to the patient, and the patient will then record in writing (whether on a physical piece of paper, or through electronic signature capture) if they want to consult the pharmacist about their therapy. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders.
Determining how long a box will last is different since each syringe is only good for 30 days after it is started, but there are five syringes. As you can tell, there are many individual little rules to try and work with when estimating how long a particular medication will last. This visual verification should be looking for an accurate interpretation of the information from the original prescription to the prescription label, that the patient information on the product is correct, the the product is packaged in an appropriate manner, and that the correct drug is being dispensed.
Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. The following is a succinct list of the other DAW codes; 3 = substitution allowed - pharmacist selected product dispensed, 4 = substitution allowed - generic drug not in stock, 5 = substitution allowed - brand drug dispensed as generic, 6 = override, 7 = substitution not allowed - brand drug mandated by law, 8 = substitution allowed - generic drug not available in marketplace, and 9 = Other. CV medications may be written for up to 1 year, although many states limit this to 6 months. Under the privacy provisions of HIPAA, the pharmacy needs to make a valid attempt at privacy during counseling whether with something as simple as a privacy screen or with an entirely separate room. If the patient seems confused about their medication, it is a common practice for the technician to strongly suggest that the patient receive counseling or even just have the pharmacist assist the patient.
Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. There is some historical overlap, however variations exist between CNSs and NPs, particularly related to education and training in pharmacology, diagnosis, and treatment. The NP clinical setting is determined by the area of specialty and may either focus on one setting (eg: outpatient) or multiple settings.
PA educational programs include various clinical environments in both inpatient and outpatient settings for all age ranges.Educational programs for APRNs are typically a blend of nursing and medical models, while PA programs are based exclusively on a medical model. The undergraduate education for APRNs prepares them for licensure as a registered nurse while the undergraduate education for PAs is typically in a health-related field. In general, NPs and PAs can perform health histories and physical examinations, order and interpret appropriate testing for further assessment and develop a treatment plan for patients with common health problems. In certain clinical settings, other testing such as electrocardiography or x-rays may also may be reviewed or interpreted by a NP or PA. Additionally, any testing, which includes a physician review and interpretation, may be utilized in their assessments (eg: sleep studies). APRNs and PAs can prescribe therapeutics including pharmacologic agents and durable medical equipment. The extent of APRN and PA formal education in pharmacology and prescribing can affect state legislation regarding the degree of prescriptive authority. APRN practice models can vary from independent practices to physician-collaborative practices while PA practices require physician supervision. The Drug Enforcement Agency (DEA) uses the term mid-level provider (MLP), The Centers for Medicare and Medicaid (CMS) uses the term non-physician practitioner (NPP), but there is no term that has been defined and supported by both APRN and PA professional organizations. It asked 14 questions that included basic respondent contact information, sleep center structure, utilization of APRNs or PAs and very basic information on roles, and why the center representatives did or did not utilize an APRN or PA. Additionally, these centers formed the sample for initial contact with the second survey (Survey 2, Part 1).
Privacy regarding provider-specific information was protected by not requesting direct contact information for the APRN or PA within their centers from the center representatives. After approval by the AASM Board of Directors, this questionnaire was distributed electronically to 1,950 AASM accredited sleep disorders centers, utilizing the email addresses provided in their AASM membership applications.
Those representatives completing the survey included a variety of roles such as physicians, technical managers, and office managers, as well as APRNs or PAs (n = 15).Survey of APRNs and PAs in AASM Member Sleep Centers (Survey 2, Part 1)To obtain more information directly from APRNs and PAs about their sleep practices, a second survey was developed and approved by the AASM Board of Directors. These individuals were asked to forward the invitation to complete the electronic survey to the APRNs and PAs within their sleep centers. Thirty-one responses were received with one incomplete questionnaire (97% incomplete) and one duplicate questionnaire, leaving 29 responses for analysis (12%). For the duplicate respondent, the first set of responses received was analyzed.Survey of APRNs and PAs in Clinical Practice (Survey 2, Part 2)After reviewing the survey responses to the second survey, the Task Force sought to obtain information from more APRNs and PAs in an effort to have broader representation of national trends, especially since only 20 states were represented in initial response to Survey 2. During the fall of 2012, the AASM hosted an educational workshop designed for PAs and NPs at their national office in Darien, Illinois.
Primarily marketed by the AASM through brochures and emails to members, the workshop was also promoted through word of mouth and internet searches, according to participant feedback.
Course participants were asked to complete the same electronic questionnaire distributed to APRNs and PAs previously (Survey 2, Part 1), their responses becoming the second part of the data collected (Survey 2, Part 2). Even though the group who received invitations to participate was much smaller than Part 1, the response rate was significantly higher, more than doubling the responses to Survey 2.
There were 44 responses to the survey, which accounted for 62% of the total number of attendees, but included 4 duplicate respondents from Part 1.
Questionnaires completed by other professions despite instructions that the survey was intended for APRNs and PAs, were removed from the analysis (4 were removed).
Although all participants in Survey 1 and Part 1 of Survey 2 had an affiliation with an AASM member center, not all participants in Part 2 of Survey 2 were affiliated with an AASM member center.Almost all respondents provided their name (on a voluntary basis) and other requested demographic information. When these demographics were not provided, there were sufficient responses regarding state, credentials, and institutions to allow the Task Force members to identify and exclude duplicate responses.
When asked about clinical responsibilities, four APRNs and one PA did not provide a response and were excluded, leaving 60 for this portion of the analysis.RESULTSSurvey of AASM Member Centers (Survey 1)Table 1 provides an overview of responses from 271 sleep center representatives. The majority of the practices were hospital-based or nonhospital-based physician-owned practices. Among the 109 centers reporting the employment of an APRN or PA, a majority reported the APRNs or PAs had clinical responsibilities providing new and follow-up evaluation, while less than half reported research or administrative responsibilities.When the AASM member center representatives were asked if they were interested in hiring an APRN or PA, 29% of the respondents indicated there was an interest in hiring an APRN or PA, while 35% reported there was not an interest in hiring an APRN or PA, and the remaining 36% did not answer the question. As expected, a high percentage of APRN and PA respondents to both parts of Survey 2 were prepared at the master's level or doctoral level (89%).
Only one respondent reported receiving specialty training in sleep during their graduate program; whether this specialty training was clinical experience or coursework was not ascertained. Smaller numbers reported being certified as Acute Care Nurse Practitioners (11%) or Pediatric Nurse Practitioners (7%). APRNs responding to Survey 2 represented 26 states, while the PAs responding to Survey 2 lived in 13 states.Almost three-fourths (74%) of APRNs and PAs responding to the two surveys reported working at community- or hospital-based centers.
Almost all (91%) of the APRNs and PAs reported spending at least 75% of their time in a clinical role with 82% reporting at least 90% in a clinical role; only 3% reported less than 50% of time in a clinical role. Based on the survey format, we were unable to ascertain if the small numbers reflected the overall lower numbers of these disorders in sleep-center patient populations or reflected a focus on other disorders by APRNs and PAs. Badr,29 regarding future models of care and the changes affecting the practice of sleep medicine, which include out-of-center sleep testing, a sharpening focus on chronic disease management, and the potential reduction in sleep-boarded physicians. Although these results may reflect the survey methods that were based largely on AASM accreditation or affiliation, the findings are still intriguing.
APRNs and PAs provide many patient-care services, including initial and follow-up visits and explaining the results of sleep studies.
They manage a range of sleep disorders, devoting most of their time to more commonly found sleep disorders, such as sleep-disordered breathing, insomnia, and movement disorders.The challenge for the future is to combine our knowledge of APRN and PA disciplines with our new knowledge of APRN (specifically NP) and PA practices currently described within sleep centers.
Although this mentored clinical education provides practical experience in the diagnosis and treatment of sleep disorders, the mentor-ship may reduce clinic productivity initially during the training period. Additionally, physician mentors must focus their time and energy on providing basic didactic instruction in sleep and sleep disorders. Perhaps, this additional education could be delivered more efficiently with a national, standardized continuing education program or formal coursework.
Based on both survey responses and informal communications with APRNs and PAs, formal sleep education for APRNs and PAs is lacking prior to employment or during their initial training in a sleep clinic.LimitationsThe first survey (Survey 1) had a number of limitations. First, because the survey was sent to AASM member centers, the results may not reflect the practices of APRNs and PAs in sleep centers that do not maintain AASM membership.
Additionally, because the survey focused on APRNs and PAs, those healthcare professionals who actively employ or are interested in employing APRNs and PAs may have been more likely to respond. The survey did not ask the respondents to note their states in which they were located thus, regional variation in ARPN and PA utilization may have been under- or over-estimated.
The response rate to Survey 1 was low and may have been explained, in part, by the role of the center representative who was designated to receive email communications from the AASM and by their interest or involvement in the topic.
Only 15 (5%) of clinic respondents identified themselves as APRNs or PAs.In the first portion of the second survey (Survey 2, Part 1), the same limitations described above could influence the response rate.
Additionally, respondents were given a relatively short time to respond during the summer vacation period.
Of the respondents to the first survey (Survey 1), 10% indicated they did not wish to be contacted again. The lack of direct or email contact with APRN and PA stakeholders probably reduced the number of APRNs and PAs who knew about and responded to Part 1 of Survey 2.
The second portion of the second survey (Survey 2, Part 2) was administered via email around the time of an in-person course advertised to a target audience of PAs and NPs (an APRN subgroup). The course participants were told verbally about the survey during the course, and this in-person invitation to participate probably increased participation rates.
The analysis was performed at Emory University, Atlanta, GA and Clayton Sleep Institute, St.
The other authors have indicated no financial conflicts of interest.ACKNOWLEDGMENTSThe authors thank the American Academy of Sleep Medicine (AASM) and Jordana Money and Patrick Murray for assisting with survey preparation, distribution, and collection of data.

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