Ask an NP – Prescribing Outside the Guidelines

00:01 Sometimes you run into a scenario where you're going to have to write a prescription that's a little bit out of the norm.

00:07 It's going to be a little bit higher than what the formulary or guidelines are suggesting.

00:12 I often run into this when I'm in the pediatric intensive care unit and I have to give patients sedation, especially when we're near the end of life, unfortunately.

00:22 Oftentimes they've gotten so used to sedative medications and other things for pain that I'm having to continue to increase the dose of those medications.

00:32 When I have to do that, I call down to the pharmacy and explain why I'm prescribing outside of the guidelines.

00:38 We have a chat about whether that's feasible.

00:40 I usually talk to somebody else on the team just to make sure they also think that this is a good idea.

00:46 And then I go ahead and put the prescription into the EHR and the pharmacist approves it.

00:53 Sometimes when you're writing paper prescriptions, it would be the same thing.

00:56 If you've got a dose that is a little bit unusual, for whatever reason, you may have to call the pharmacy or you wait until that prescription is turned into the pharmacy by the patient, and then that pharmacist is going to call you because they're looking for dosages that are out of the range of normal.

01:14 Once you get in touch with the pharmacist and you can explain your thinking, then you should be able to get the prescription filled.