MPAS Order and Prescription Writing Policy

To describe standardized procedures for order and prescription writing for PA Trainees in the Clinical Rotations year (Year 2) of the Master of Physician Assistant (MPAS) program.

PA students in their second year of the MPAS Program function as supervised clinical trainees and do not hold independent practice authority. Their clinical participation is determined be demonstrated competence and direct supervisory oversight.

The Designated Preceptor and/or identified Supervisor is responsible for orders and prescriptions written by physician assistant students under their supervision. Patient safety and student learning are optimized by effective discussion and oversity of orders and prescriptions.

Countersignature: Refers to a second or confirming signature on a previously signed document. It is a blind signature to something that was unwitnessed. It does not imply that the second person provided the service, only that that person approved or verified the service or record was completed (as defined in SHA Policy).

PA Trainee: A student in their second year of the MPAS program, who is completing clinical rotations - a core part of their educational program - as a supervised clinical trainee.

Designated Preceptor: The clinical supervisor who is ultimately responsible for the supervision of an MPAS student in a particular practice or service, usually a licensed physician or licensed/certified Physician Assistant. The designated preceptor oversees the student’s clinical learning experiences and assessments. If applicable, they oversee any student engagement with other MD faculty, PAs, residents, or other health care providers. Designated Preceptors may be:

1. Licensed/Certified Physician Assistant (note: Given the supervisory relationship of the Licensed/Certified Physician Assistant and their Supervising Physician, it is expected that the Licensed/Certified Physician Assistant Preceptor will work with their Supervising Physician to clarify any potential implications of Preceptorship).
2. Licensed Physician
3. Most responsible physician: the medical staff member deemed most responsible for a given patient’s (or group of patients’) care; also referred to as ‘attending physician’.
4. Consultant physician: A physician involved in the care of a patient on a consultation basis.
5. The on-call physician for a particular practice or specialty.

Supervisor: Any individual, including a supervising physician, a licensed/certified physician assistant, MD faculty, nurse practitioner, resident, or other non-physician health care provider who may be involved in teaching and supervising a physician assistant student during a clinical learning experience.

This policy applies to instances where students in the Master of Physician Assistant Studies (MPAS) program at the University of Saskatchewan in the second year of the MPAS Program are involved in the care of patients, irrespective of the geographically distributed site/campus to which they are currently assigned.

Note: MPAS Students in Year 1 (Clinical Sciences) of the MPAS Program cannot write orders on patient charts and cannot write prescriptions.

Related policies include:

• Saskatchewan Health Authority (SHA) - Clinical Documentation & Communication Standard – Practitioner Orders
• Saskatchewan Health Authority (SHA) - Clinical Documentation & Communication Standard – Co-Signing/Counter-Signing

Documentation

In all documentation including Orders, Prescriptions, etc., PA Trainees are required to document who they discussed the case with and include the name of the direct supervisor below the Learner’s signature.

For example, following the documentation, Learner signature, and co/countersignature, Learners should include the following:

• “annotated by (Learner Name), PA Student, for Dr. (Physician Name).
• “annotated by (Learner Name), PA Student, under direct supervision of Dr. (Physician Name).

Order Writing

Physician Assistant Trainees are authorized to write all necessary orders for investigations and treatments of their patients, after discussion with their Designated Preceptor or Supervisor.

All orders must be written on the appropriate order form and must have clear documentation of agreement prior to implementation (e.g. Countersignature) by the Designated Preceptor or Supervisor, or Most Responsible Physician or other approved prescriber (e.g. Nurse Practitioner) before being acted upon by Pharmacy or Nursing. Where applicable, the Most Responsible Physician or supervising resident may confirm the order by phone. A countersignature from the MRP or supervising resident is still required at the next available opportunity. PA Trainees must not change an Authorized Prescriber’s orders without their approval.

Prescribing

PA Trainees may write prescriptions after discussion with and under the supervision of their clinical supervisor, except in the case of controlled drugs and narcotics. PA Trainees are not authorized to prescribe controlled drugs or narcotics.

All prescriptions must be written on the appropriate form and must be clearly countersigned by the Designated Preceptor, the Most Responsible Physician, or other approved Prescriber before being acted upon by Pharmacy or Nursing.

The Academic Director of the MPAS program is responsible for providing oversight to the overall administration of the MPAS Order and Prescription Writing Policy.

The Director of Faculty and Clinical Placements of the MPAS Program and the Manager of the MPAS program, with assistance from the MPAS Office, are responsible for the implementation, monitoring, maintenance, and evaluation of the MPAS Order and Prescription Writing Policy. This includes the development and stewardship of the standard operating procedures associated with this policy.

Instances or concerns of non-compliance with the MPAS Order and Prescription Writing Policy should be brought to the attention of the Academic Director of the MPAS Program and will be addressed through relevant MPAS program and/or SHA policies.

Academic Director, Master of Physician Assistant Studies (MPAS) Program