Please help!!! New NP Dilemma :(

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Hi All,

I am a new Nurse Practitioner working in an outpatient surgical department. This department has 3 well experienced surgeons, 1 chief PA and 2 Nurse Practitioners. This practice, the surgeons are old timers and having major challenges with online prescription as their Electronic Medical Record is a nightmare to navigate. All 3 surgeons still writing prescriptions routinely. On a daily basis, they will write controlled drug prescriptions to give to the patient and many times the patients request to send their medicine order to their pharmacy online so that that they can pick up the medicine on the way home. This falls on me. Other times patients will call the practice to request controlled drugs for pain management. At this time, the surgeons will write prescription and fax to the pharmacy which thy will reject the order.

This is a real dilemma for me as a new NP working in this practice, as I am forced to prescribe controlled drugs for the entire practice because no one else can order this online. I have never seen the patient and no where in the chart what pain medication the surgeon previously ordered. The surgeons will not write why the patient needed the controlled drug, what other options they have tried, how long are they planning to give etc. I am not talking about few weeks post operative pain control. Patients are taking it for years.

What should I do in this situation? Any suggestion??

Thank you All

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Specializes in ICU, LTACH, Internal Medicine.

(you bring a pack of written, but unsigned, scripts, smiling shyly and sweetly):

- Good morning, Dr. Jones, how are you doing? Yeah, I've did calls for (X,Y,Z), and got (D, F, H) ... and (A,B, C) need their pain meds, I already wrote all scripts for you ... here they are... would you mind to sign them for me, PLEASE (and keep smiling:)

If any question, state that you are new and pharmacies bother you with calls to "clarify" everything because they are not familiar with you, your NPI and your DEA. Whether it being true or not :)

Another way is to request a meeting with your physicians and practice manager and state, that, since you willy-nilly became Mr./Ms. EMR Runner/Script Writer for the whole place, they make up some order to at least make it all look legally acceptable for you. Especially if you work in "fully independent" state. Do not forget to ask for a little raise for your efforts doing so.

I do not work in "independent" state, so all my controlled scripts (and I do a whole heck of them since I run hospice part of practice among other things) go under my collaborating physician's name. I still write down why I change/do not change dose, especially when things get escalating. But in any case becoming a script writer for a whole place is not a pleasant position, so make some efforts not to put yourself there.

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Katie,

Thank you for your input. I am going to give it a try as you suggested. My collaborating physician is scared of computers:)

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Specializes in Nephrology, Cardiology, ER, ICU.

This is a recipe for disaster with all the opioid awareness campaigns currently in the news.

I practice in IL where online Rx'ing of schedule IIs is a no-no so I have to write everything out.

I moved your thread to the NP forum also.

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TraumaRUs,

Thank you. here in NY, writing is only if computer issues or few doses of emergency supplies

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What should I do in this situation? Any suggestion??

Thank you All

Talk to the practice manager. A protocol needs to be established for this, and that is his/her responsibility. If the EHR is very bad and difficult for the providers to use then they should change it. Do not let them put this over on you. Every state is tightening up their regulations about the prescribing and dispensing of controlled meds now. You should not be prescribing controlled drugs for patients whom you have not seen and don't even know, especially if the prescriptions are for chronic pain management. If you keep doing this you may one day find yourself in trouble with the board of nursing, and they will not be interested in hearing excuses.

If they are going to make you the defacto computer prescriber then they need to set up a protocol for that---whereas the physicians MUST write out their orders, including what the drug is being prescribed for, and a copy of this should be put in the patients' charts every time. Then the script is entered into the electronic prescribing system under THEIR names and DEA numbers, not yours. And if you are willing to take on this responsibility then they should pay you something extra for it.

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"set up a protocol for that---whereas the physicians MUST write out their orders, including what the drug is being prescribed for, and a copy of this should be put in the patients' charts every time. Then the script is entered into the electronic prescribing system under THEIR names and DEA numbers, not yours."

True. I am going to give it a try.

Thank you for your response

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Here are my options if I were you:

1. Patient requests online prescription on a patient seen by another provider so that they can pick the medication up from the Pharmacy on their way home. My response: "sorry your provider does not do online prescriptions, you're going to have to bring that written prescription to the Pharmacy yourself and wait for the Pharmacy to fill it".

2. Pharmacy denying faxed prescriptions (which they should because that's illegal for controlled substances). My response: Call that patient at home and say "there's a prescription for narcotic pain medication waiting for you at the office. We can't call or fax these".

3. Meeting with the MD's and teaching them how to do online prescribing themselves. We recently got signed up for this and with our Epic EMR, a valid state issued ID is required of the provider in order to be signed up. Were all the providers enrolled in e-prescribing for narcotics? if not, that's probably the issue.

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I couldn't agree with you more. Make sense. Thank you

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Specializes in OB.

But I think the issue is (and correct me if I'm wrong, OP) that you HAVE to e-prescribe everything, even narcotics, in NY state. Unlike many states that actually require narc Rxs to be on paper, in NYS I don't believe they work at all, either hard copy in hand or by fax. That's why all providers have to get enrolled in e-prescribing narcs and know how to use the system. Writing them all out and just asking them to sign them wouldn't solve the problem (and I wouldn't do that anyway even if it would). I would talk to the practice manager or the doctors themselves. You are not a scribe, nor their servant, you should not be doing that.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

You're right LibraSun...but that mandate to e-prescribe narcs in NYS took effect March 27, 2016! so OP, since you are new to the practice, how were prescriptions being done before you started? was there another NP that did that and was fed up with it so much as to resign?

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There was a PA who was giving out narcotics like candies:)

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