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.

[CapeCodMermaid, RN]

I haven't heard of this regulation. We need to fax scripts for certain meds but not for Ativan or Vicodin. If we take anything out of the med kit, we need a script. For sure I'll be calling the pharmacy tomorrow.

[RedCell]

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.......

This would be a great line for you to tell the greasy trial lawyer in you deposition. "The pharmD (yes another person who can actually obtain a doctorate besides an MD or DO) told me this would stop the patient's heart but dammit...."My BOSS told me to push the marcaine intravenously and I always do EXACTLY what my BOSS says".

Dude, is this REALLY the way you run your nursing practice?

[SuesquatchRN, BSN, RN]

Is this only LPNs or RNs also? It isn't clear from your title. I did take verbal orders for controlled substances as an LPN.

[CapeCodMermaid, RN]

It's any nurse-LPN or RN. I spoke to my pharmacy and was told that this has been a regulation for years but now the DEA has started to try to enforce it. Just simply ridiculous.

[noc4senuf]

This is federal. I have had this in place since March. It is an old law but, no one ever paid any attention to it. Because Omnicare is the largest in the nation, they were the ones who got the initial ding from the authorities. You can get an order over the phone BUT, you still need the script to get it filled. You can get the narc out of the e-kit BUT, before it is repaced in the e-kit it needs a script. We are now running quite smoothly iwth all of this in place. It takes a bit getting used to. Don't forget that the scripts need to have a quantity listed on it.

[SuesquatchRN, BSN, RN]

You can get an order over the phone BUT, you still need the script to get it filled. You can get the narc out of the e-kit BUT, before it is repaced in the e-kit it needs a script.

As long as I can get it from my e-kit I'm good.

Thanks.

[Zen123]

I work in a Skilled LTC unit and we were informed of this 2 weeks ago w/c took effect. We are not allowed to get any starter from the C Box of any Schedule 11 Narcs order unless we have the form signed by the MD and Pharmacy has to have it in their hands before you can obtain the Narcotic.

A hard lesson learned when 2 days later after hearing of this I had a new admit who was in a LOT of pain d/t Severe Osteoarthritis, etc... She came in having only PRN Tylenol order. It made for a hellish two days at work having to deal with a very angry ' don't want to be bothered' MD on the Phone and having to have DON take over the situation

d/t angry family very upset why it's so hard to get a response from this MD.

FYI:

Keep in mind when receiving phone orders from MD- Know your list of schedule 2 Narcs and bring it to their attention to try something else so u can obtain it from the C Box. The first chance you get with the MD on the phone may be your last.

[nckdl]

Yes my facility also started this about 6 months ago. It took awhile to get things started and get paperwork for it, but it does get easier. The only complaint I have is that Hospice people are suffering when they get a new order for Roxanol or Ativan or is a brand new resident, I have to track down the Doctor on the weekend for him to call in the scripts to the pharmacy. And yes that is what we did, but he got upset and told us to have the pharmacy call him. We waited 5 hours before we got the ok to pull it from our C-box.

[IMABSNRN]

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.

[Zen123]

Three weeks ago we were told that this only affects the scheduled 2 Narcs. Today I was told it

is for all and any Narcotics. yikes!

[southernbeegirl, BSN, RN]

it's happening to us in LTC because we are considered a "home" environment. therefore, we have to have hard copy prescriptions before the pharmacy can fill any narcotic, just like a patient discharged to home from the hospital does.

it's the DEA that is classifying us in this group. i wonder if a letter writing campaign from nurses, patients and family members of how patients are having to suffer in pain would work?

[CapeCodMermaid, RN]

It has nothing to do with a homelike environment. It's always been one of the regs but only recently has the DEA started enforcing it. I guess they've solved the problems of drugs in schools and drugs coming in from other countries so now they have time to target those dastardly 89 year olds who need Percocet for their fractured hip.