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  • 1.  Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted yesterday

    Hello 

    We are looking to implement the Medication Refill Protocols in In Basket workflow and would like to get feedback on if organizations that have implemented this within their EHR-

    Do the support staff approve/sign per protocol or Pend and route to the clinicians?

    Which roles (MA, LPN, RN) primarily complete this work in your organization? 

    Any feedback or insight would be much appreciated. 

    Thank you, 

    Carrie



  • 2.  RE: Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted 10 hours ago
    Hello Carrie,
    Our organization has been using the EPIC refill protocols in our primary care practices for several years, and we are now exploring opportunities to expand the drug classes included. Increasing the number of medications eligible for protocol‑based refills will allow a greater proportion of requests to be processed efficiently.
    EPIC's recommendations indicate that up to 88% of refills can be managed through these protocols. While I'm not fully comfortable reaching that level yet, expanding our use of the protocols will help reduce in‑basket burden and minimize delays in getting medications to patients.
    In our current workflow, Medical Assistants complete the refill process. If a medication meets all required criteria (such as recent visit, upcoming appointment, and necessary labs) the MA signs the order. Medications that do not meet criteria are pended to the provider for review.
    Hope this is helpful!
    Best ~
    M

    Melissa Taylor, MSN, RN, AMB-BC, NE-BC

    Director of Ambulatory Nursing

     Primary Care & Ambulatory Care Coordination

    Elliot Clinical Services

    Phone: 603-663-3503

    Email: mtaylor@elliot-hs.org

     

     

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  • 3.  RE: Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted 9 hours ago

    Good Morning Carrie!

    We utilize the Health Catalyst Embedded Refills program, that has been integrated into our Epic EHR. It allows our medical directors to determine the exact medications they wish to delegate, as well as the parameters for refill (visit within x-months, appropriate lab value within x-months, etc) for each medication. The Health Catalyst program then guides our team members in whether the medication refill request passed protocol (can be refilled for up to one year), or failed (missed appt, lab result below threshold, etc) in which case our team members are allowed to provide one courtesy 100-day supply, and help the patient address the reasons for protocol failure.

    We allow RNs, LPNS, and certified MAs to approve/sign refill medications within our Health Catalyst database following the standards above. The majority of the refills are completed by our certified MAs given the strict guardrails that we have put in place. In rare instances, or for medications that are not delegated (controlled substances, etc), the team member will pend and route to the clinician.

    Hope this helps! Health Catalyst has been an incredible tool for us.



    ------------------------------
    Emma Alonso RN, MSN, CNL
    USFTGP Physician Services Educator
    emmaclarke@usftgp.org
    ------------------------------



  • 4.  RE: Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted 8 hours ago

    Hi Carrie,

    The quick response is:  Only RN's, LVNs, and Pharmacy Technicians can approve (sign) refills via Standing Medical Order (order mode).  If criteria and not met they are routed to a physician / APP.  The provider must co-sign the order with-in 48 hours.

    Detailed Response:
    We began our implementation journey in 2023 with Epic refill protocols. As a large academic facility with over 70 specialty departments, we chose not to adopt the Foundation Epic protocols and instead developed our own internally.

    Because we were already using Standing Medical Orders (SMOs) to approve refills, it made sense to customize our protocols based on existing criteria. This approach minimized disruption and avoided workflow changes for both staff and providers. However, this required a substantial effort.

    We partnered closely with our Clinical Decision Support (CDS) build team and a pharmacisit to define rules and our Workflow Informaticist team conducted thorough testing in a support environment before piloting in a single service line. Cardiology was selected for the pilot due to their well-established SMO processes and use of pharmacy technicians to approve refills. Since this is their primary function, their real-time feedback was extremely valuable.

    While Epic provides 84 defined protocols, we have developed approximately 235. Currently, 75–80% of refills are processed using protocols. This success is largely due to our initial focus on medications that could be safely delegated to staff for approval.

    Our team is now expanding to include provider-focused medication protocols, ensuring that drug-class-specific information is readily available without requiring manual chart review. Non-delegable medications are assigned an "always fail" criterion so staff can easily identify and route them to the appropriate provider. With the use of filters, these can be quickly sorted and forwarded.

    This process requires ongoing oversight. Any changes to an SMO must first be approved by the Service Line Medical Director and then reviewed by an SMO committee consisting of RNs, pharmacists, physicians, and APPs. No protocol changes are made without this governance process.

    Although ongoing maintenance is required, the initial implementation was a significant undertaking and took approximately two years to complete. Historically, our percentage of refills processed within 1 day were in the low 80's, we now are consistently in the mid 90's.  - Hope this helps!




  • 5.  RE: Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted 5 hours ago
    Vanderbilt Health has recently implemented this practice.  I have cc'd Kelsey Bossung and she manages this area. We currently have LPN's doing this process with protocols in place for medications they can automatically refill.  I am sure Kelsey would love to talk to anyone about this.  Feel free to reach out to her.
    Thank you 

    Joanie Jeannette, DNP, RN, NEA-BC, FACHE

    Associate Nursing Officer | Vanderbilt Medical Group and Vanderbilt Health Services

    Adult Ambulatory Nursing | Vanderbilt Health

    joanie.jeannette@vumc.org | Cell:  615-970-0224

     

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  • 6.  RE: Medication Refill Protocols in In Basket (Rx Request workflow)

    Posted 3 hours ago

    I would caution anyone using medication refills to check your state scope of practice.  Meds can only be ordered by a licensed provider and if MA or RN or lPN are signing the orders, they are practicing medicine without the proper license. 

    Check your state scope to make sure you are not setting yourself up to get thrown under the bus if a mistake is made 



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    Elizabeth
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