Open Forum

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------

Unfortunately, I am in an academic medical center where we use EPIC and the cma is allowed to "load" or pend medications for refills. I accept the policy , but I find it annoying. There is one cma whom I can trust and scan what she has pended; there is "rarely" an error waiting to happen. Depending on the education and experience of the cma, many get the names of the meds confused, such as loading trazodone for the patient who requested tizanidine. If medication reconciliations are not up to date, they may load an expired or incorrectly dosed medication that was already changed. They may pend an expired Rx, or they do not read the last progress note the way an RN would which sometimes indicates a plan to change the dose on the next refill. 

I encourage all of my patients to make their requests directly through EPIC's MyChart, so I don't have to deal with possible  cma interpretation. 

Most of my medication refills are for opioid analgesics, which I do not think the cma should be allowed to touch (my opinion). One helpful cma took it upon themself to load hydrocodone 40 mg ER tab every 12 hours because the patient called and said that the insurance no longer covered their OxyContin 40 mg every 12 hours. The on-call provider signed it.  The only problem is that 80 mg a day of hydrocodone = 80 MME: while 80 mg of oxycodone = 120 MME. Big mistake and not helpful.  After that one, the cma's were only allowed to pend an order that had been previously filled (not make up their own 'helpful' orders). They also load refills for me on patients that I have not seen in the past 3 months because my name was on the original script, or they believe I will manage the issue sooner than another provider. I have to waste time re-routing it either back the cma or to the past provider who last evaluated the patient. 

EPIC does have a lot of ways to increase productivity by implementing the five fingers found on any hand; but any errors remain the responsibility of the licensed provider and any negative consequence are suffered by the patient.

Having the meds routed to the pharmacy before signing sounds like it would require additional EHR programming and IT costs. Keep in mind, every time you remove a safety step you increase your error rates. These processes are creating an artificial way of allowing the cma to take "verbal orders" without "really" taking a verbal order. Why not insist that providers (typically physicians) get organized and do some of their own work? 

Giving more skills to cma's who can "type" should not be a replacement for nursing leadership making the argument for why they need an RN in the mix to properly assess, monitor, lead, and/or supervise what the cma does. 

Aleesa

---------------