List of CIII medications for pain

[AtlantaRN, RN]

anyone have a link or a list of CIII meds for pain? We have a new protocol which

has our patients go to their own local phamacies for medications. Patients and nurses

at my hospice are not happy about this change (especially patients without caregivers

in the home with them...one more thing the patient has to do for themselves).

Anywhoo, anyone with a list of CIII meds. It's alot easier to order a CIII medication

over the phone than try to find the medical director or PMD after hours to WRITE of a CII.

Last week at IDT, I wrote out, on order forms each patients CII meds, but of course most of the pharmacies required the original with the md's DEA number written on it with

his signature. The office staff was upset that the patients had the "original" because they

said it "has to stay on the chart", then HOW does my patient get their CII med filled when

the pharmacy requires the original?

Thank you for your help!

linda

[leslie :-D]

are you confident that ciii meds will help your pts?

wow, this is nuts.

these pts shouldn't have to be worrying about this nonsense.

leslie

[aimeee, BSN, RN]

That sounds like a policy that is not patient service driven. In fact, your post shows the unintended effect... the difficulty of obtaining the medication is driving use instead of what would be the best medication for relieving the symptoms. The trouble with CIII's is that you quickly reach the ceiling dose so if your patient is in a pain crisis they are out of luck.

[AtlantaRN, RN]

Yes, this is a corporate driven issue. My manager was suprised that the local pharmacies would require an original to dispense. I went through this with my former employer, and it didn't last long. At least with the former employer, hospice pharmacia would generate a "prescription" for the physician to sign and they would authorize to dispense directly to the pharmacy.

I agree that hospice patients shouldn't have to be worrying about this mess.

linda

[Whispera, MSN, RN]

"The office staff was upset that the patients had the "original" because they

said it "has to stay on the chart", then HOW does my patient get their CII med filled when

the pharmacy requires the original?"

Where I worked there had to be an original delivered to the local pharmacy for any controlled substance medications to be dispensed, and had to have the prescriber's license number as well as DEA number on it. Most docs don't put both numbers on their prescriptions until they've signed them. Some don't put either number on the forms until signing them. The numbers aren't pre-printed on the forms. That prevents someone from stealing the pads and using them to get unprescribed drugs.

I've also prescribed, and in my practice it was possible to get Rx forms that had a carbonless duplicate. The duplicate could be kept on the chart in the doctor's office. I'm wondering if part of the problem is that the doctor's office you spoke of required the "original" rather than a duplicate. Maybe the office staff at the doctor's office is uninformed?

[twinkle_ears]

what a pain. i completely feel for you. whenever i get a hard script i make a photo copy and place in the pt chart and write on it original to pharmacy. its the law that the pharmacy have the original. you can find a list of all cii and ciii at dea.gov and follow the links on the left for scheduling of meds. this isn't just pain meds but it is a list. also there is a link to the dea guidelines/laws for when a pharmacy is allowed and not allowed to dispense. this might help your office staff understand that the original must go to the pharmacy. we also just had an issue were a pharmacy wouldn't fill a cii even with a hard script because "it was too soon" so we now have to write "terminally ill hospice pt" on all hard scripts even though the script pad has our company logo on them. a final note i would be concerned about switching my pts from cii to ciii because of the obvious; pain. i just invision my case load all having uncontrolled pain at the same time because i switched meds. which means a bad day for all involved.

[solsken]

lists of CIII meds isn't the issue here...

First of all, most states, if the patient is in hospice will allow for a FAXED CII script as long as the words "For Hospice Use" or "Terminal Patient" etc is used. You should have the name of a good homecare company or compounding pharmacy who can help you set this up and get this done wtih a smooth transition. When I worked homecare/hospise I would routinely call the physicians office (or fax) with "This is what the patient has left, this is what he/she has used in the last 24-48 hours and please write a script FOR... and FAX to..."

Second of all Wikipedia is good for a few things, here is a list they took right from the DEA... it isn't easily read but at least you can click on links and see exactly what is what.

http://en.wikipedia.org/wiki/List_of_Schedule_III_drugs

Good Luck

Solsken, RPh