Public Health Law Map - Beta 5 - Medical and Public Health Law Site

a. Penicillin V potassium 250 mg q.i.d. in adults, 30 mg/kg per day in 4 divided
doses for children.
b. If the patient has red TMs or pustular tonsils, give amoxicillin 250 mg t.i.d. in
adults and children over 45 lb, 125 mg t.i.d. in children over 15 lb.
c. If the patient is allergic to penicillin, give erythromycin estolate 250 mg q.i.d. for
adults, 30 mg/kg per day in 4 divided doses for children.
d. If the patient is intolerant of both penicillin and erythromycin, consult the
physician.
Following this treatment protocol requires reasonable skill by the NPP in
determining the correct medicine and calculating doses. It does not, however, allow
any exercise of judgment as to which drug to use. That is defined by the
characteristics of the patient.
d) Follow-Up
When NPPs are working from protocols, it is particularly important that patients be
given specific instructions about when to be rechecked. Because there is so much
delegated medical judgment involved, it is important to ensure that the patient has
received all the necessary and appropriate care:
Follow-Up
1. Return to the clinic if not improved in three days or if fever continues this long.
2. Return to the clinic in two weeks for recheck.
3. Return to the clinic immediately or go to the emergency room if you develop
respiratory distress, rash, or fever greater than 102°F.
e) Referral
Inherent in the practice of protocol medicine is the need for physician backup when
the problem falls outside the scope of the protocol or the particular practice. A
family physician may make a practice of referring all patients with cardiac
arrhythmias to a cardiologist. This is not a legal requirement; it is just good sense.
A nurse practitioner who is working off protocols must refer patients who have
problems beyond the scope of the protocols or the practice. The inclusion in the
protocol of specific reasons for referring allows the physician to highlight
conditions that are of particular concern. The protocol also may branch to other
protocols if indicated:
Refer
1. Refer to the physician all patients with a rash, a heart murmur, or who appear
toxic.
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