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7 tips for additional prescribing authorization applications

January 21, 2014

Submitting your application for additional prescribing authorization? Read these tips first to make sure you avoid some common pitfalls.

  1. Include documentation in the patient care record. The narrative is valuable to assessors, but it is NOT part of the patient record. The sole purpose of the narrative is to guide the assessor through the actual documentation you provide.

    As outlined in the Case Checklist, assessors are looking for care plan and monitoring plan information in the actual patient record – the actual record of care. This may be paper-based or electronic, but must be authentic. In other words, it must be created at or near the time you provided the care; not created for the purpose of the application. 

  2. Document at the same time you provide care. Assessors are noticing that in some applications, documentation appears to be done weeks, even months, after the actual event. While this alone is not an automatic reason for an applicant to be unsuccessful, it may contribute. If you did not document when the event happened, it’s best to find another case where you documented the care in a timely manner. 
  3. Take responsibility for decisions about drug therapy problems. Assessors note that many applicants identify drug therapy problems (DTPs) and communicate them to the physician for the physician to assess and decide how to proceed.  Assessors are looking for you to complete a thorough assessment and develop a care plan. They are gauging your ability to assess the patient, develop a care plan (i.e., prescribe, monitor, and follow up), collaborate with other health care providers, and document your actions. Asking the physician what to do about a DTP is not indicative of collaborative prescribing; making a suggestion with a strong rationale and plan for the physician to consider is.
  4. Demonstrate all the key activities for pharmacist prescribing in your cases. For example, a case where a pharmacist makes an adaptation to another dosage form or changes the medication due to coverage issues may not be a good demonstration of assessment and often no care planning or follow up is demonstrated. Assessors are looking for the pharmacist to complete a full assessment, make a decision, and complete follow up.
  5. Show that you have completed a holistic patient assessment. This means that all medications should be assessed, at minimum, for efficacy, proper dosing, and indication. For example, even if the drug therapy problem is a lack of medication for preventing shingles, assessors expect that you will review all of the patient’s medications at the time of assessment. If this is not shown, and assessors note other potential problems, then they may be left to wonder whether you identified the issue or not, and if or when you plan to address it. 
  6. In your follow up plans, document who will be responsible for completing the follow up. In many instances, this will be a combination of you and the physician, and/or others, such as nurses. Do not imply; state the information directly in the care plan.
  7. Complete and document some of the follow up before submitting your application. Many applicants have included a monitoring plan, but submitted their application before the plan is carried out. As outlined in the Case Checklist, assessors will be looking in your documentation for implementation of the follow up. This may mean delaying your application submission, but will increase your chances of success.