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

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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.:banghead:

In what universe are nurses "agents of the prescribers"? I don't work for the facility docs. I work for the facility. I am an agent of the facility and have to do what the facility AND the scope of the nurse practice act determine to be correct. If it insists that I follow the DEA directive, I will. At the same time, I will speak my mind and make my concerns known as I cannot believe that patients in pain are well served by this directive.

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Specializes in Management, Emergency, Psych, Med Surg.

Well, the facility is responsible for setting up a procedure that will meet the DEA requirement and meet the needs of the patient at the same time. Now I don't work LTC but I would imagine that one thing that would be required is a good assessment on nights and early on days to determine the pts pain needs so that you can get in touch with the physician during regular hours so you can hopefully get the pain meds ordered before you will need them for after hours.

That being said, what ever system the managers come up with they have to suffer with. And I guarantee you that if they come up with some stupid policy that says that a certain person has to be called at all times when this issue comes up, after you call them at 3 am for about two weeks in a row, they will figure out another way to go about it. You won't get what you need until they have the problem dumped in their lap. And it gets dumped in their lap when they are called at 3 am.

I imagine that the DEA has a very good reason for making this change in rules and I am sure that all of us are going to suffer some changes in the way we administer and prescribe pain medications. Abuse of "legal" pain medications has gotten so out of hand.

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Specializes in LTC, ER, ICU, Psych, Med-surg...etc....

This is crazy. Maybe when everybody is admitted we Nurses will have to get a PRN order for pain med, however our narc drawers will be full and we will have the duty of counting all the stuff that most won't ever use, but what do you do? Call the doctor and get a script? Good luck. Call the pharmacy and get them to call the doctor for an ok?- haha that is even funnier....

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Specializes in Rehab, Infection, LTC.

has anyone heard any new info?

The office of aging (congress) sent the DEA a very strongly worded letter on oct. 16. they have obviously been listening to nurses and docs about this. the letter lays out specifically the problems pts are facing now. they even went so far as to tell the DEA that while we are trying to follow their guidelines/laws that we are being tagged by CMS for not treating pts for pain. we are damned either way. the letter requested that the DEA respond within 20 days but i havent found any response from them yet.

keep writing congress guys! drown the office of aging with letters! we have got to get this changed.

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Specializes in Geriatrics, WCC.

southernbee, where did you find the info?

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ABSOLUTELY-UNDER NO CIRCUMSTANCES-GIVE THAT MED! It doesn't matter if your boss or anyone else tells you to! Unless you have a hard copy in your hands-either from the doctor or the pharmacy-you could be charged with diversion! Your boss will not take the fall for you-this is a DEA regulations and IDK about you-but I'm not trying to take on the DEA.

If your boss or any other nurse is so certain the med can be given-kindly explain to them that you feel uncomfortable doing so until the RX is in your hand; however, they could give it if they feel comfortable. ...its their license-not yours!

Psych issues-pain issues-whatever-if the circumstance requires a written script and you dont have one-I have one "word" for you-----> ER. CYOA

Even if the doctor says-just give it and I will fax you the order in the morning--kindly explain how much you wish you could do that; however, the DEA regulations will not allow you to do so.

I pray this harshly interpreted reg changes-its in the best interests of our patients to revisit this issue and put a stop to the insanity. Stand-up and advocate for your patients-they depend on us and together-we can speak LOUD to initiate a change.

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The issue has to do with the Controlled Substances Act and the DEA's interpretation of a long standing law and how it conflicts with longstanding practices in long term care. The confilct is actually two-fold. First the DEA does recognize chart orders to be legal. A prescription for controlled substances needs to contain the full name and address of the patient, the drug name, strength, dosage, form, quanitity, directions for use, plus the full name, address and registration number of the prescribing physician. In addition the prescription must be signed and dated on the issue date. According to the DEA the pharmacy/pharmacist must have a hard copy in hand before issuing the drug. This practice works fine in hospital and ambulatory settings, but not in nursing homes and facilities where the physician is not available 24/7. Long term facilities typically fax chart orders to the pharmacy and then dispense the drug at the facility or wait for the pharmacy to fill the order. The second part of the problem stems form the DEA not recognizing the nurse as a legal agent of the physician. Therefore a nurse cannot act as a go between the physician and the pharmacy regarding orders for controlled substances. Please note that the DEA is not the regulatory body only the enforcing body. The DEA it is enforcing a law that in practice does not work in the long term care setting. For many years the standard of practice has not been an issue.

Agencies such as the AMDA, ASCP, AMA and others are working with legislators and the DEA to see if the laws can be changed in a manner that is consistent with longstanding practices. However due to the recent focus on health care reform our legislators are preoccupied. In the meantime long term care facilities must alter the practices to coincide with the law. In addition they must find a way that the drugs being issued are available in a timely manner as to not violate federal regulations regarding resident care in nursing facilites. The DEA penalties are severe and include hefty fines for pharmacies and facilities for each occurence as well as loss of licensure for nurses.

This is a serious matter that could affect how long term care facilities function, how drugs are made available and the role of nurses and physicians in long term care. Contact your local and state legislators and find out what they are doing regarding this matter. Also research national and state health care organizations to find out what is being accomplished in reagrds to changing the laws.

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Specializes in Rehab, Infection, LTC.
southernbee, where did you find the info?

our pharmacist sent me a copy of the email from the office of aging to the DEA.

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Specializes in ALF/SNF.

Ha, I thought this was just my facility.... guess not. First of all, this is quite ridiculous. Second of all, we just had an inservice on this. Every nurse got a paper on how to handle this situation... on one of the bulletins it says "Nurses can always suggest alternate pain meds that we have in the EDK in lieu of C II meds" Are we the prescribers now? How about a Vicodin instead of a Percocet? What a load of crap! I do not feel comfortable "suggesting" alternate narcs.... not sure about you guys!

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Specializes in Rehab, Infection, LTC.
Ha, I thought this was just my facility.... guess not. First of all, this is quite ridiculous. Second of all, we just had an inservice on this. Every nurse got a paper on how to handle this situation... on one of the bulletins it says "Nurses can always suggest alternate pain meds that we have in the EDK in lieu of C II meds" Are we the prescribers now? How about a Vicodin instead of a Percocet? What a load of crap! I do not feel comfortable "suggesting" alternate narcs.... not sure about you guys!

since this went into place, i've asked for TONS of orders for ******* tramadol. not much else left to give :o

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Specializes in Gerontology, Med surg, Home Health.
Ha, I thought this was just my facility.... guess not. First of all, this is quite ridiculous. Second of all, we just had an inservice on this. Every nurse got a paper on how to handle this situation... on one of the bulletins it says "Nurses can always suggest alternate pain meds that we have in the EDK in lieu of C II meds" Are we the prescribers now? How about a Vicodin instead of a Percocet? What a load of crap! I do not feel comfortable "suggesting" alternate narcs.... not sure about you guys!

I have always felt comfortable suggesting meds and treatments to the docs. They like it since they have to think less if I have already thought of a good plan.

One way around some of this is to have a good working relationship with the discharging hospital. Ask the docs to send scripts with the patients for any narcs they have ordered.

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Specializes in ALF/SNF.

Well, there are 4 big hospitals in this area.... kinda hard to get them on board with our facility and our policy. It happened last night, and the patient ended up getting Vicodin instead. Still think it's crap though. Thanks for the suggestion!

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