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

PennStudent · Oct 8, 2009

This is the first I've heard of this, and when I brought this up to my nurse manager (RN) she had no idea about it. We always take telephone orders from doctors, fax them to the pharmacy, and then get whatever we need.

Does someone have a link or something to this? I'd like to bring this up with the RN's.

noc4senuf · Oct 8, 2009

Go to the http://www.ascp.com and scroll to the bottom of the page and click on DEA news. My pharmacist actually sent me a link to a whole booklet but, am unable to send it.

Zen123 · Nov 1, 2009

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.

- THANKS a million. This is a great Idea. We have 1 Dr. that wants the Phamacy to call him regarding scripts; BUT I was unsure how to go around the others who I have to hunt. I usually faxed over the order to Pharmacy and call to give them the MD.'s number. You think the MD.'s would be cool and not bite my head off if I put their contact # on the order itself?

nursenow · Nov 1, 2009

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.

Zen123 · Nov 1, 2009

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.

In my facility we are not allowed at all to get the schedule 2 from the e-kit until Pharmacy received the Script.

nursenow · Nov 1, 2009

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.

It is hard to believe that such a wide reaching decision like that, one that affects every LTC an and pharmacy in the country has not been brought to the attention of every pharmacy and LTC in the country. I seriously doubt our pharmacy would willingly break federal laws on a daily basis if it were true. When we fax order our meds there is a box we check if we gave the first dose from the e-kit. If we check that box the pharmacy deducts that dose from the total to be delivered. (our supplying pharmacy is owned by a national Corp that has them county wide)

rapkeygurl · Nov 2, 2009

yes another example of tying the nurses hands behind her back!!! You better give that pain medicine!! but how you get it is beyond me lol. I have never looked as myself as an "agent fo the prescriber" I just thought that you were suppose help the resident when they hurt and I teach ours to do that quickly so I guess I better get all the docs in my facility on speed dial as well. After enough 2am calls they might get the laws changed lol.

noc4senuf · Nov 2, 2009

It was just in McKnights Long Term Care News last week that enough of us nurses have contact our congressmen and senators that they are putting the pressure on the DEA to lighten up.

indigonurse · Nov 2, 2009

sounds like an issue that needs to be brought to the medical director of your facility's attention. This will call for a change in your policy. Then an inservice to the MD's that admit residents to your facility. From what you say it sounds like after you get a verbal order from an MD the MD needs to call the pharmacy. This would mean that a pharmacy would need to be available to take the calls 24/7. If a resident has a change of condition or pain then the nurses must notify an MD doesnt matter what time of the day or night. This all comes down to assessment. If a resident experienced sudden, severe, unusual pain I would want to send them to the hospital unless they had an advance directive requesting no hospitalization. I dont understand how an MD could perscribe a pain med without knowing what the cause is.

CapeCodMermaid, RN · Nov 2, 2009

I don't think you live in MY world...speak to the medical director?? He doesn't answer his phone half the time. Tell the docs what you want. I've been in the business for more than 25 years and the docs still don't get it. My pharmacy told me the DEA has to have something to do and going after nurses in LTC is far safer than going after the drug lords who bring in tons of cocaine.

rapkeygurl · Nov 3, 2009

See the OBRA ACT of 1987 says we have to give pain meds and reassess the effectiveness in a timely manner ?? hm and we have to make a doc call the pharmacy ours is 4 hours away. WE dont have an e-kit and if our people hurt after 10pm they go to the hospital period because we dont keep anything stronger than vicodin. We asked the pharmacy to give us and e-kit with narcs but they avoid this so we just send them out. Poos resident that has horrible compression fractures for example get out in the cold on a stretcher to get pain meds. What is wrong with this picture??? Yes I live close to the mexico border the DEA could surely go watch out for some loads of dope crossing but yes that is dangerous and slapping a cuff on a nurse seems much easier

blueeyes87 · Nov 5, 2009

Yep we just got a letter put up in our nursing home sayng we are no longer allowed to remove narcs from the e-kit without phamacy approval. We must fax over a sheet that they will confirm or deny that we have the right to open the ekit. There have been a couple instances that pharmacy has denied our request even though it was a refill order to begin with. We've been told we'll be written up if we dont follow protocol. So until we get things straightened out hopefully tylenol holds out the pain. Its sad because it takes away the whole purpose of an E-kit and leaves residents in pain. :crying2: