Prescribing Authority and NP Malpractice Risk

Nurse practitioners (NPs) hold a vital position within the healthcare system, as they provide essential care to millions of patients. A major aspect of their role is prescribing authority, which has expanded over the past few decades. This increased autonomy, however, brings with it an increase in professional accountability and potential liability. Every practicing NP should examine the connection between prescribing authority and NP malpractice risk to protect patients and their professional standing.

This article explores the relationship between an NP’s authority to prescribe and their exposure to malpractice litigation. We will cover the different levels of prescribing authority, identify the most common medication-related errors, and outline proactive risk management strategies that NPs can implement.

Understanding NP Prescribing Authority

The scope of prescribing authority for nurse practitioners varies from state to state. These regulations influence an NP’s autonomy and their corresponding liability. Generally, states fall into one of three categories for NP practice environments.

Full Practice Authority

In states with full practice authority (FPA), NPs can evaluate patients; diagnose, order and interpret diagnostic tests; initiate and manage treatments; and prescribe medications, including controlled substances, without physician supervision. This model grants NPs the highest level of autonomy and positions them as independent practitioners. While FPA allows NPs to serve patients more effectively, especially in underserved areas, it also places the full weight of clinical responsibility and liability squarely on their shoulders. Any error in prescribing judgment falls directly on the NP.

Reduced Practice

In reduced practice states, state law requires a career-long regulated collaborative agreement with another health provider, typically a physician, to provide patient care. This collaboration might involve limitations on the setting or scope of one or more elements of NP practice. For example, an NP may need a physician to cosign a certain number of prescriptions or have limitations on the types of medications they can prescribe independently. While this model provides a layer of oversight, it does not absolve the NP of liability. A prescribing error could result in a claim against the NP and the collaborating physician.

Restricted Practice

Restricted practice states impose the most stringent limitations. They require career-long supervision, delegation, or team management by another health provider for an NP to provide patient care. A physician often directly oversees an NP’s ability to prescribe in this environment. Prescriptions may require a physician’s signature, or the NP may only be able to prescribe from a limited list of medications. Despite this high level of supervision, NPs are still accountable for their actions and can still be named in a malpractice lawsuit related to a prescribing error.

Common Prescribing Errors Resulting in Malpractice Claims

Medication-related errors are a leading cause of malpractice claims against nurse practitioners. These errors can occur at any stage of the prescribing process, from initial assessment to patient education. Awareness of these common pitfalls will enable effective risk management.

Common areas where prescribing errors occur include the following:

• • Incorrect medication selection: Choosing the wrong drug for a patient’s condition is a frequent source of claims. This can happen due to a misdiagnosis, a failure to consider a patient’s full medical history, or a lack of knowledge about alternative treatments.
• • Wrong dosage or frequency: Administering an incorrect dose can lead to serious adverse effects or render the treatment ineffective. Errors in frequency (for example, prescribing a medication twice a day instead of once) also pose a risk.
• • Failure to monitor: Many medications require ongoing monitoring of a patient’s response, including lab tests or follow-up appointments. Failing to establish and follow a monitoring plan can result in undetected side effects or a lack of therapeutic effect, both of which can lead to patient harm and subsequent litigation.
• • Inadequate patient education: Patients must understand how to take their medication correctly, what side effects to watch for, and when to seek further medical advice. If an NP fails to provide clear instructions, and the patient suffers harm as a result, the NP can be held liable.
• • Ignoring drug interactions and allergies: A thorough review of a patient’s current medications (including over-the-counter drugs and supplements) and known allergies is essential. Overlooking a potential drug interaction or prescribing a medication to which a patient is allergic can have catastrophic consequences.

Strategies for Mitigating Prescribing Risks

Any NP with prescribing authority must practice proactive risk management. Implementing consistent, evidence-based practices can reduce the likelihood of a medication error and strengthen your defense in the event of a claim.

Maintain Meticulous Documentation

Thorough documentation is an NP’s best defense in a malpractice case. Your patient records should tell a complete and logical story. Document the clinical rationale for choosing a medication, the dosage and frequency, and any patient education provided. Record conversations about potential side effects and the patient’s acknowledgment of this information. If you decide against a particular treatment, document why.

Adhere to the Standard of Care

The standard of care is defined as what a reasonably prudent nurse practitioner with similar training and experience would do in the same or similar circumstances. This standard is established through clinical practice guidelines, expert testimony, and professional literature. Staying current with evidence-based guidelines for the conditions you treat is crucial. Your prescribing decisions must always align with these accepted standards.

Leverage Technology and Clinical Support Tools

Utilize electronic health record (EHR) systems with built-in clinical decision support. These tools can automatically flag potential drug interactions, dosing errors, and patient allergies. While they are not a substitute for clinical judgment, they serve as an invaluable safety net. Additionally, consult with pharmacists, collaborating physicians, and other specialists when faced with complex prescribing decisions.

Prioritize Continuing Education

Pharmacology is a constantly evolving field. New drugs are approved, and new information about existing drugs emerges regularly. Committing to lifelong learning through continuing education (CE) courses focused on pharmacology and prescribing practices will help you maintain competence and reduce risk.

Secure Comprehensive Insurance Coverage

Even the most diligent NP can face a malpractice claim. Having solid professional liability insurance for nurse practitioners is a fundamental component of a sound risk management strategy. This insurance provides financial protection and access to legal experts who can defend your practice and reputation. Ensure your policy limits are adequate for your scope of practice and the state you work in.

Protecting Your Practice for the Future

The expanding role of nurse practitioners, particularly their authority to prescribe, is a positive development for healthcare access and patient care. However, this autonomy comes with undeniable professional risks. Thoroughly understanding prescribing authority and NP malpractice risk is indispensable for navigating your career safely and effectively.

Stay informed about your state’s practice laws, adhere to the highest standards of care, document everything, and embrace a culture of continuous learning to minimize your liability exposure. Protecting your practice allows you to focus on providing excellent care to your patients.

Baxter & Associates has provided healthcare professionals with reliable malpractice coverage since 1996. Our experts can help you secure a policy that’s right for your practice’s needs. Contact us today for a comprehensive quote, and protect your career.