blank signed scripts

[hospicevet 20, ASN, RN]

Does anyone have any opinions about having blank signed scripts for the on call nurse? I am working for a hospice and the medical director has signed a couple of scripts, to be filled in with what we need, for example roxanol, ativan, or whatever, when we need them afterhours and may not be able to get a signed script from the attending physician. I gotta say, this feels really hinky to me, and even though the DON has reassured me that the med director will cover it, I'm just not comfortable with this practice. I am not a NP, and don't have prescriptive authority. Am I just making a big deal over nothing?

[tewdles, RN]

No, not making a big deal over nothing...

there is nothing legal about this practice and you (and the agency and the MD) would be in trouble if this practice were publicized...

It is far better for your agency to work with a local pharmacy to create an "emergency drug kit" for your oncall staff that contained the most commonly needed meds. The staff would still need to contact the MD for the order but they would have a supply already available to them. This is helpful for things like injectable morphine, valium, or scopolamine.

Having said that, the management of those "kits" (including the meds, the orders, and the prescriptions) becomes an important and often challenging task for the management team.

[heron, ASN, RN]

One assumes you would get the verbal order from the MD and then use the pre-signed rx to get it filled. In my state, pharmacies may not fill prescriptions for narcotics that are called in ... we must present a paper script.

Even if it was a rewrite for an existing order, I would speak with the MD first.

So ... using those guides, you aren't actually prescribing - you are implementing a verbal order.

The hinky part to me is the potential for diversion. That's why, on my inpatient unit, I made sure to notify the prescribing MD that I was using one

ETA: to speak to tewdles' point, we did have an e-kit and then a pyxis that served the same function, but in the inpatient setting we often had to initiate tx fast and couldn't wait until the next morning for the paperwork to catch up. We also often had a problem with running out of iv meds when the patient was being rapidly titrated. I can see the same thing happening in the field, ie with new admits in severe pain, sudden onset of new symptoms, allergic sx with available meds, and so on. It can be a tough problem.

[caliotter3]

I sure wouldn't want to be in a position to have access to these scripts. Just asking for trouble at some point in time, and I wouldn't want to be the one being accused of wrongdoing.

[tencat]

Our office used to do that, and I was never comfortable with it. There are many things that can go wrong. The powers that be decided that maybe it wasn't such a good idea after all and scrapped it. It can be a pain to try to get meds for someone in a rural area or in a place where there are not 24-hour pharmacies. Our company has now contracted with a courier service, which has helped.