When prescribing controlled substances for patients in long-term care settings, doctors should use these tips to assure the right drug in the right dose gets to the right patient—and avoid problems with the U.S. Drug Enforcement Administration—suggests a coalition of physician groups.
The coalition consists of physicians, medical directors, and others practicing in skilled nursing and other long-term care settings:
- American Medical Directors Association
- American Medical Association
- American Academy of Family Physicians
- The American Geriatrics Society
- The American Academy of Hospice and Palliative Medicine
The groups say they are concerned because the DEA recently instituted changes in long-standing prescribing practices that have resulted in delayed drug delivery to their patients.
"These changes forced on us have delayed dispensing of controlled substances to long term care facility residents who urgently need them," says Meenakshi Patel, MD, director of geriatrics at Miami Valley Hospital in Dayton, OHI and an AMDA member who helped develop the tip sheet.
Cecil Wilson, MD, president of the AMA, says the organizations want to change the interpretation of the rules, however, "revising laws and regulations can be a long and complex process and physicians must ensure their patients' current health needs are addressed."
"Currently DEA interpretation of the existing regulation means that patients are going without needed pain relief. This simply should not be happening," added Cheryl Phillips, MD, AGS board chair. "We believe it's essential that practitioners have information about complying with the DEA regulations and so we worked collaboratively to develop this tip sheet. The group said the tips should help physicians who prescribe controlled substances for patients in long-term care facilities avoid running afoul of DEA rules and deal with aggressive enforcement actions by DEA agent."
The coalition this week issued a tip sheet to help physicians ensure proper prescribing of controlled substances "and deal with aggressive enforcement actions by agents of the DEA."
1. Prescriptions for Schedule II controlled substances should be made in writing and signed by a DEA-registered practitioner.
2. If the situation is an emergency, a pharmacist may dispense the drug after receiving oral authorization directly from the physician.
3. If the physician calls in an emergency prescription, the prescribing physician must still follow up with a written prescription within 7 days of that verbal order.
4. Always carry a prescription pad that meets the requirements of the state you're practicing in.
5. Know what information is required for a controlled substance prescription to be legal, such as:
- date of issue
- patient's name and address (such as the nursing facility)
- practitioner's name, address and DEA registration number
- drug name
- drug strength
- dosage form
- quantity prescribed
- directions for use
- number of refills authorized, if any
- manual signature of prescriber.
6. Write your prescriptions at a facility with a fax machine and fax the prescription to the provider pharmacy rather than calling it in.
7. Purchase a home fax for after-hours and weekend calls.
8. In emergency situations, when you are unable to fax a script, or do not have a prescription pad available, call the pharmacist directly and provide him or her with the order, in addition to providing it to the nurse.
9. Don't give a verbal order to a nurse when you are onsite at a local facility. Instead, write the prescription when you are still in the facility and have it faxed to the pharmacy.
10. Become a local change agent by reaching out to local hospitals to educate staff so patients who require controlled substances are discharged with a hard copy prescription for several days' worth of their needed medication. The prescription should specify the drug, but also say "or formulary equivalent."
The coalition is working with Congress and the DEA to allow nurses to act as the physician's agent, which the coalition described as "a long-standing practice." But, the groups said, "changing laws and regulations is a long and complex process, however, and our patients can not wait."