Signing prescriptions with “as per…”
Q: I’m an RN working in a family physician’s office. The other day, Dr. Smith asked me to give a client a new prescription on her behalf because she was busy with another client. She instructed me to write the prescription and sign my name followed by, “as per Dr. Smith.” Can I do this?
A: No, you cannot sign the prescription as the physician requested. Even if you write “as per Dr. Smith,” signing your name would mean you authorized the prescription. RNs and RPNs do not have the authority to do this.
Since Dr. Smith was physically present in the office to instruct you, the safest practice would be for her to personally write and sign the prescription. Then, you could either give the prescription to the client or fax it to the client’s pharmacy through a secure fax line.
Furthermore, Dr. Smith’s instruction is a verbal order which is not appropriate in this situation. Verbal orders are only allowed in emergency situations or when the prescriber is unable to document the order. (For more information on verbal orders, read the Authorizing Mechanisms practice standard.)
If a client needs a prescription and Dr. Smith isn’t in the office, Dr. Smith could communicate the order by telephone. You should repeat the order back to Dr. Smith to make sure the information is accurate and document it in the client’s chart. Then, phone the pharmacy with the prescription and speak directly to the pharmacist; do not leave the telephone order on voice mail. After giving the pharmacist the prescription, ask the pharmacist to repeat the prescription back to you. Document the details of the phoned-in prescription in the client’s chart – this should include the name of the pharmacy, day and time you phoned in the prescription and the name of the pharmacist who transcribed it. Pharmacists may request your name and registration number for their records.
For more information, read the Decisions About Procedures and Authority practice standard.