to the writer
please response o student and professor in less than 150 words each in single line space . thanks
Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.
General instructions:
Review the scenario and address the questions below.
You are a nurse practitioner employed in a busy primary care office with responsibilities for managing the office staff, including the medical assistants who aid in client care as well as filing, answering calls from clients, processing laboratory results, and taking prescription renewal requests from clients and pharmacies. The office is part of a larger hospital system. One of the medical assistants has worked in the practice for 10 years and is very proficient at her job. She knows almost every client in the practice and has an excellent rapport with all the providers.
During an office visit, a client requested a refill for an amoxicillin prescription. When examining the empty bottle, you noted that the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber though you did not see the client last week. The client explained that she called last week concerned about her cough and spoke to the medical assistant, who assured her that a prescription would be sent to the pharmacy for the concern. You do not recall having discussed this client with the medical assistant; the other providers in the practice deny speaking to or consulting about the client.
Include the following sections:
Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
Based on the situation above, what are the ethical and legal implications for the practice at the micro-, meso-, and macro-level of the system?
What changes do you recommend to prevent further episodes of the problem behavior? What coaching and feedback skills can be used to discuss the event with the medical assistant?
Which change model would you use to implement the identified change and why: Lewinâ€s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotterâ€s 8-Step Process for Leading Change?
Identify and discuss one barrier to implementing the change process. Identify and discuss one factor that facilitated the change process.
Integration of Evidence: Integrate relevant scholarly sources as defined by program expectationsLinks to an external site.:
Cite a scholarly source in the initial post.
Cite a scholarly source in one faculty response post.
Cite a scholarly source in one peer post.
Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
Peer Response: Respond to at least one peer.
Faculty Response: Respond to at least one faculty post.
Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
Reference Citation: Use current APA format to format citations and references and is free of errors.
PEER 1 post /Alyssa
A. Based on the situation above, what are the ethical and legal implications for the practice at the micro-, meso-, and macro-level of the system?
A medical assistant prescribing Amoxicillin or any medication for that matter under my name without consultation is a serious breach of scope of practice which includes illegal forgery and severe ethical violations. This risks patient safety and invites malpractice liability for myself. At the micro-level, this action is unethical as the MA acted outside their legal scope of practice. The MA is also guilty of practicing medicine without a license and forgery. Without proper assessment this can lead to antibiotic resistant microorganism and even more severe adverse events such as an allergic reaction. At a meso-level it represents a breakdown in trust and team dynamics. This clinic faces liability and can potentially damage the reputation of the clinic. At a macro-level this action may lead to stricter oversight policies across the entire entity. Not to mention again, continues to antibiotic resistance from inappropriate usage.
B. What changes do you recommend to prevent further episodes of the problem behavior? What coaching and feedback skills can be used to discuss the event with the medical assistant?
To prevent unauthorized prescribing and to address the issue with the medical assistant I would likely use multiple approaches. To start, I would recommend a mandatory scope of practice training, this would be annually for all clinical staff. Implementing a formal prescription protocol, this would be a written policy that explicitly states that only NPs, Pas, MDs, DOs can authorize medications. Lastly, I would find a way to work with IT to restrict prescribing privileges within the EHR so anything placed would await provider review before being sent to pharmacy.
C. Which change model would you use to implement the identified change and why: Lewinâ€s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotterâ€s 8-Step Process for Leading Change?
I think for this specific scenario, Lewinâ€s Theory of Planned Change is the most effective model for implementing these necessary changes. This model focuses on the psychological transition and behavioral shifts (Bazzi, 2022). required in a small scale, high stakes clinical setting.
D. Identify and discuss one barrier to implementing the change process. Identify and discuss one factor that facilitated the change process.
There may be a resistance to these new safety protocols. In such a clinic, the medical assistant may have prescribed the Amoxicillin to be helpful and by implementing a mandatory pending provider review step in the HER, the MA might feel like the workflow is now less efficient. This can lead to other workarounds where staff try to bypass the system again to satisfy patients. To overcome this, I would have to emphasize that patient safety outweighs clerical speed.
Reference:
Bazzi, D. (2022). Approaches to a contemporary psychoanalytic field theory: From Kurt Lewin, Georges Politzer and José Bleger, to Antonino Ferro and Giuseppe Civitarese.The International Journal of Psychoanalysis,103(1), 46–70. https://doi.org/10.1080/00207578.2021.1964971Links to an external site.
Faculty . The Professor DR Prator/POST/question
This discussion is always interesting to me. What if the MA did speak to the NP about the refill and the NP did approve it but just does not remember? Does that change our recommended repercussions? Why or why not? If so, how?
