DEA States that LTC Nurses Are No Longer Agents Of The Prescribers

We were recently made aware of this new policy. Apparently, the pharmacy can okay this with the MD over the phone. I fax TO's to the pharmacy with the MD's phone number and they call him themselves. It must work because I've never had any trouble this way.

We get an order in the middle of the night, administer it from the e-kit and fax an order to the pharmacy. they then contact the MD to get his signature(and other info). It has definately increased the amount of time to get a narcotic filled. We still take the T.O. but it has changed the way the pharmacy has to deal with the MD.

Last month our pharmacy stated that the DEA has began issuing citations that add up to millions of dollars to LTC facilities that have nurses who accept telephone orders for narcotics from MD's. This includes vicodin, ativan, xanax, etc. The pharmacist states that they must have a hard copy of the written script in their possession before we can administer this medication. This means that even though we have vicodin and ativan in our Omnicell, we can not administer it to the patient that is screaming in pain. What happened to nurses providing nursing care? I feel so helpless. I work the 11p to 7a shift. Pharmacy states that I can call the MD and explain to him what I need and that he can call pharmacy and give them a verbal order and then after they speak with the MD they will fax us a written script to give this med. Pharmacy can accept the order but we can't. How many MD's do you know that are going to do this at 2am in the morning? How is this going to look when state comes in and we've been documenting a patient's pain level at a 10 and that all interventions are not working? I thought pain was what the patient says it is and is to be treated. I guess that I'll be sending more people to the ER to get their pain under control at night. It just seems like this is one more way to hamper safe care for our residents. For example, about a year ago I had a new admit to our lock down unit that came in with no psych meds ordered. At midnight he has jerked the fire extinguisher off the wall and is swinging it around like a lasso. I got an order for IM Ativan and was able to get the fire extinguisher away from him and keep my other residents safe. If this situtation occurs again, my hands are tied. Are any other facilities going through this type of situation? If so, how are you handling this? I did google DEA regulations just to make sure that our pharmacies info was on the up and up and what I've been told is legitimate info. Any help would be appreciated.