I Didn't Pull An Order For That Out Of My Rear End

[tencat]

Hi all. I am having a heck of a time with another agency who also is in the homes caring for patients. I work hospice, and I am only with a patient a few hours a week. This other agency provides 12-24 hour care in the home for some of our patients for diaganoses not related to hospice. These nurses, bless their hearts, are with one patient for many hours and have to deal with the families of said patients. Some of them are great and get hospice and what we're doing. But some of them constantly stonewall everything hospice tries to do. My main issues are with medication administration. The nurses from this company will not give medications if they don't have an order written by the physician in the home. Some will not accept verbal orders written down as being official orders since they don't have the physician's signature on them. My issue is that if a medication shows up at a patient's house with his/her name on it, the physician's name on it, and is obviously sent from a pharmacy, WHY do they need official orders to give it?????? Isn't it a given that there ARE orders for it to be administered if it has the patient's name on it and is current???? Our doctor is not available to write out orders most of the time. He is available by phone for verbal orders which he signs at a later date, but we can't wait for that when a patient is having 10/10 pain. Am I being unreasonable? Is there a legal issue with all of this that I'm not understanding? Any advice appreciated.

[Asystole RN]

They may be referring to Section 5 of the DEA's "Practitioner Manual" that requires a prescription for all CII meds. The DEA specifies that an order for a CII is not a prescription and gives specific requirements for a prescription.

I know at my facility we are very strict about this. No CIIs are dispensed until we have a written prescription. Verbals are strictly forbidden.

http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm

Practitioner's Manual

SECTION V – VALID PRESCRIPTION REQUIREMENTS

Prescription Requirements

Aprescription is an order for medication which is dispensed to or for an ultimate user. A prescriptionis not an order for medication which is dispensed for immediate administration to the ultimate user (for example, an order to dispense a drug to an inpatient for immediate administration in a hospital is not a prescription).

A prescription for a controlled substance must be dated and signed on the date when issued. The prescription must include the patient’s full name and address, and the practitioner’s full name, address, and DEA registration number. The prescription must also include:

1. drug name
   
   
2. strength
   
   
3. dosage form
   
   
4. quantity prescribed
   
   
5. directions for use
   
   
6. number of refills (if any) authorized
   
   

A prescription for a controlled substance must be written in ink or indelible pencil or typewritten and must be manually signed by the practitioner on the date when issued. An individual (secretary or nurse) may be designated by the practitioner to prepare prescriptions for the practitioner’s signature.

The practitioner is responsible for ensuring that the prescription conforms to all requirements of the law and regulations, both federal and state.

Who May Issue

A prescription for a controlled substance may only be issued by a physician, dentist, podiatrist, veterinarian, mid-level practitioner, or other registered practitioner who is:

1. Authorized to prescribe controlled substances by the jurisdiction in which the practitioner is licensed to practice
   
   
2. Registered with DEA or exempted from registration (that is, Public Health Service, Federal Bureau of Prisons, or military practitioners)
   
   
3. An agent or employee of a hospital or other institution acting in the normal course of business or employment under the registration of the hospital or other institution which is registered in lieu of the individual practitioner being registered provided that additional requirements as set forth in the CFR are met.
   
   

[diligent-trooper]

I can understand your issue. They may be simply verifying the physician's original order. Just in case, an error has occurred in transcription:coollook: by whomever: doctor, nurse, pharmacist.....

[Esme12, ASN, BSN, RN]

They may be referring to Section 5 of the DEA's "Practitioner Manual" that requires a prescription for all CII meds. The DEA specifies that an order for a CII is not a prescription and gives specific requirements for a prescription.

I know at my facility we are very strict about this. No CIIs are dispensed until we have a written prescription. Verbals are strictly forbidden.

Excellent reference...........also sounds to me someone got burned.........

[Altra, BSN, RN]

Could the solution here be standing orders for each hospice patient for predictable symptoms - breakthrough pain, nausea, increased secretions, constipation, etc.? If these orders were written for each patient admitted to hospice it might avoid the issue of a lack of a written order.

[netglow, ASN, RN]

So, the MD phoned pharmacy and ordered a narc. Narc was delivered to pt. home. The primary caregivers (RNs ?) will not give these meds?! What are they looking for that is not already on the script bottle? Do they give BP meds, or even insulin? If so, what is their rationale for giving those meds then? I don't understand what they want? They must assess for many other drugs as well as narcs.

[morte, LPN, LVN]

They may be referring to Section 5 of the DEA's "Practitioner Manual" that requires a prescription for all CII meds. The DEA specifies that an order for a CII is not a prescription and gives specific requirements for a prescription.

I know at my facility we are very strict about this. No CIIs are dispensed until we have a written prescription. Verbals are strictly forbidden.

however, the pharmacy would have been in receipt of the script, prior to the dispensing of the med......there for that base has been covered.

[netglow, ASN, RN]

however, the pharmacy would have been in receipt of the script, prior to the dispensing of the med......there for that base has been covered.

Yes, MD must provide DEA license # when ordering, or script will not be filled.

[Asystole RN]

however, the pharmacy would have been in receipt of the script, prior to the dispensing of the med......there for that base has been covered.

At least not at my facility, we need a copy or original of the script...not just the order. We don't care if the pharmacy has the script...we want it to cover our butt...not the pharm's.

[Asystole RN]

So, the MD phoned pharmacy and ordered a narc. Narc was delivered to pt. home. The primary caregivers (RNs ?) will not give these meds?! What are they looking for that is not already on the script bottle? Do they give BP meds, or even insulin? If so, what is their rationale for giving those meds then? I don't understand what they want? They must assess for many other drugs as well as narcs.

MDs can no longer phone in CIIs. They must write...physically write a script and fax or send per DEA rules.

[netglow, ASN, RN]

OK, well shows ya how long ago last I worked for an MD. (seriously cramps this guy's style, I can imagine. Private practice, loves baseball...). Huh, PDA sending of? He'd do that in a second. I am sure there is an app for that.