Page 17 - Part 2 Collaborating with Advanced Practice Providers - An Overview of State Rules

SVMIC Collaborating with Advanced Practice Providers

Medical Record Review

Physicians also have medical record review responsibilities for the

patients being treated by APPs. Most states require only a random

sampling of a small percentage of medical records, but the statutory
minimum should be just that – the minimum. Many states require all

records falling within a set of parameters (such as when a prescription

for a controlled substance is written or upon patient request, etc.) to be

reviewed and countersigned by the physician. It is also a risk

management best practice to carefully monitor the APP and consider
reviewing most records during the initial employment period. This may

be the best window of opportunity to discuss and instruct on the

method of diagnosis, ordering, referrals, tracking, follow-up care

recommended as well as documentation. Ensure the printed record

serves as evidence of, and adequately supports, personal oversight and

review.

Alabama

For nurse practitioners, specify a plan for quality management with

established patient outcome indicators for evaluation of the clinical

practice of the CRNP and a review of a meaningful sample of medical

records plus all adverse outcomes. Develop a systematic process to

accomplish this and review the patient outcome indicators.

Regarding physician assistants, the supervising physician shall review

PA prescribing practice weekly by reviewing a minimum of 10% of

patient charts for which prescriptions are written. However, every patient

who has not responded to treatment or who has unusual problems shall

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