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

[chase4myheart]

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.

[mindlor]

Here is the way I think.....

My boss is the one that says that I get to keep my job...not the Pharmacist.

I would run this by my boss, then do EXACTLY what my boss said.......

[chase4myheart]

Administrator and DON are going by what pharmacy says.

[Katnip, RN]

The reason the pharmacist can take the oder is they are filling it, not administering it. That's what I think, anyway.

I do wonder what CMS is going to say about this.

[mindlor]

Sometimes the best way to bring about change is to give people exactly what they ask for.

Once the people in charge are severely bitten by your doing as you were told......

They will then begin to tell you differently.

I am sure everyone is familiar with the old saying....

"Be careful what you ask for...."

Sadly the patient will be caught in the crossfire.

It is possible to take the moral high road and do what you know is right, but sadly that road leads right on out the front door.....

The way I think is this......

To properly run the LTC, a pharmacist will have to be on-call for crises.

Also I would think the rules will vary State to State eh???

[Alibaba]

Actually, we have been dealing with this for a while in our facilities. The only difference is that we are able to take a verbal order for narcotics and such, pull from the e-kit and administer. The pharmacy however will not fill any of these meds without a hard copy script. Of course if the stuff you need is not in the e-kit or if you run out before a script is sent (which can take forever coz the docs dont get the importance) .......

[Not_A_Hat_Person, RN]

I work in LTC, and we've been dealing with this since May. We still reorder narcs the same way we reorder other meds, but the pharmacy calls us back every time, and we have to fax and call the doctor's office every time. It's a huge waste of time.

[Reigen]

WOW!!!!!!!!!

I have trouble just getting a telephone call back from attending physicians on abnormal labs, or my favorite--- when a Resident called 911 and local law enforcement and told them they had been kidnapped and were being held agaist their will, the physician NEVER responded. Been over 3 months ---I'm still waiting for a return call. The Medical Director wasn't to happy about me calling and letting this be known, to him after 2 hours of calling the physician 5 times.

With these new DEA Regulations, I am sure it will be an interesting time. I look forward to having the Medical Director on speed dial...

[VivaLasViejas, ASN, RN]

Thank you, Nanny State............

[EverNurseRN]

great. so when a patient needs a new order for pain medication i can say 'oh sure, just gimmee a few hours and i'll have it for you.' yeah right. absolutely ridiculous. all i can say is document, document, document so that when a family member complains that their mom was in excruciating pain all night and you didn't do anything, you'll have proof that you did everything you could.

[Schmoo1022]

Oh brother....this seems like it is going to be awful! Those poor, poor patients! I can understand the pharmancy would like a hard copy. This would be great in the real world. I can honestly say, I don't think it would go over well in my facility, since we have been known to wait and wait for a MD to call back. I know more than one nurse that would send these residents to the hospital for uncontrolled pain if the MD didn't call back/call the pharmancy. Is this a state to state thing?

[OC_An Khe]

It is not a state to state thing but it is federal. I am guessing at the rationale is that the DEA wants either the MD to personally evaluate the patient before prescribing a controlled substance or it is some bureaucrat that has been able to get this regulation past who has no idea how the real world works. Actually I wonder whether it has to be an MD providing the hard copy but rather anyone who has a DEA number and is able to write a script?

I know there has been a push to get rid of all verbal orders especially when EMR's get implemented.