Long-Term Care Leaders Speak Out About Pain Medication Regulations

MacKenzie Kimball, March 25, 2010

Long-term care leaders spoke about how a federal program impedes nursing home residents from getting necessary medications at a Senate Special Committee on Aging hearing on Wednesday.


Both the American Association of Homes & Services for the Aging (AAHSA) and the National Community Pharmacists Association (NCPA) submitted written testimonies urging the committee to address the Drug Enforcement Agency's (DEA) interpretation of the Controlled Substance Act (CSA) that they said creates a barrier to providing nursing home residents with pain medication in a timely matter.

Nursing home physicians typically work for multiple facilities and are not always in the facility to provide written orders for prescriptions. Because of this, physicians sometimes communicate new orders for the resident over the telephone, especially when a resident's condition changes quickly. When this occurs, a nurse records the physician's verbal order in the resident's chart. This documentation is known as a "chart order."

If this chart order calls for a new prescription, the nurse faxes the chart order to a long-term care pharmacy for dispensing. Using the chart order to fill and dispense a prescription ensures "that medications are acquired on a timely basis to meet residents' changing and emergent medical needs," according to an AAHSA press release.

However, the DEA's interpretation of the CSA does not allow for controlled substances, such as many pain medications, to be filled based on nurses' chart orders. The DEA regulations require that a pharmacy can only fill and dispense controlled substances if they have a signed prescription from a physician.

According to the AAHSA press release, "This additional step means that nursing home residents may be forced to wait hours, or even days, to receive medication for pain, seizures, psychiatric, and end-of-life symptoms at times when physicians are hard to reach."

The industry-wide concern for this issue arose from the DEA's recent audits of multiple long-term care facilities and pharmacies for filling controlled substance prescriptions for nursing home residents based on chart orders.

"We believe that the DEA is undermining the ability of pharmacists to address controlled substance pain medications needs in long-term care facilities in a timely manner, which can lead to unnecessary suffering for residents with serious health challenges," Bruce T. Roberts, RPh, executive vice president and CEO of NCPA, said in a press release.

Both AAHSA and NCPA expressed interest in working with Congress and the DEA to establish a viable solution to this problem.

MacKenzie Kimball MacKenzie Kimball is an associate editor in the long-term care market at HCPro. She writes PPS Alert for Long-term Care and manages MDSCentral.
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