Question #1. You are a Family Nurse Practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers.
Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of Amoxicillin with her and asked if she could have a refill. You noted the patient's name on the label and the date on the bottle was one week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie, nor do the other providers in the practice.
Discussion Question:
What is your next logically sound course of action? Provide evidence to support your response.

Question #2. Upon further investigation, you learn that Stephanie spoke with the patient and called the medication into the patient's pharmacy without consulting with a provider. Stephanie claimed that the patient was insistent about needing a prescription. Since Mrs. Smith was coming into the office the following week for an appointment, she didn't think you would mind if the patient received the prescription early.
Discussion Question:
What are the ethical-legal concerns associated with this situation? Provide evidence to support your response.

Question #3. Due to the incident, you are concerned with office policies and procedure. Upon investigation, you find there isn't a policy in place to address non-urgent patient requests for prescriptions.
Discussion Question:
What quality improvement strategies might you implement as an APN in this practice to safeguard your role and assure patient safety? Provide evidence to support your response.