Sharing prescriptions of non narcotic medications

Nurses General Nursing

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If you work in a doctor's office you know that you are the one that writes the prescriptions, fills out all of the disability paper work, etc., and the doctor simply signs on the dotted line. I would like to throw out this scenario that happened recently in my office.

Patient calls and reported that both she and hubby take the same medication, same strength and wanted a new prescription. However, she only wanted one prescription with double the strength so the both of them could split the pills. This way they only needed to pay for one prescription. Now, granted, this at first appears to be a reasonable request.

If a doctor writes a prescription knowing the strength is double the prescribe amount to save the patient money, is it legal? But wait, the doctor never writes the prescription they only sign it, the nurse writes the prescription. I am all for helping saving patient's money, but not at the cost of potentially jeopardizing my license in the process. To go one further, if the doctor writes the prescription for one patient at double the strength knowing that this prescription will be shared by two patient's ???????????

It is against the law to take medication that is not prescribed for you. I really dislike being put in the position to say NO, but ethically / legally I feel this isn't right. What say you all?

Specializes in Clinical Research, Outpt Women's Health.

OMG - many of y'all are so not real world.:smokin::smokin::smokin::smokin:

The point I have tried to make is it not up to the nurse./QUOTE]

It IS up to the nurse to decide to do it himself/herself or hand it over to the doctor and make him/her do it. In this case I would say absolutely NOT. If the physician wants to do it, he/she is welcome to, but I'm not willing to put my name on it all and have it come back to bite me in the posterior if a patient decides to take a double dose, ends up hurt by it, and lawyers up....

Specializes in Med/Surg, Ortho, ASC.
Well that's a big change from the norm since my years in doctor's office/outpatient clinics. We never wrote out all the doctor's prescriptions for them to sign. It seems as if there is confusion about who actually writes the prescription if a nurse's written instruction would vary from what the doctor thought he was ordering when he signed the Rx. Why can't they write their own prescriptions? Normally it takes less than a minute to fill it out.

My personal PCP writes out her own scripts, but any surgeon I've ever worked for always had me write out the scripts. They would sign anything I put under their noses. Further, they didn't want to be bothered with refill requests or initial call-ins for new scripts. And to be honest, it was better that way: I have caught more than one MD in a very wrong dose or sig. in my experience, most surgeons just don't want to be bothered with remembering dosages, quantities, instructions, etc.

It's illegal for someone to take prescription medication that isn't prescribed to them (not just controlled meds...all prescribed meds). Practitioners don't write "family" prescriptions, they're written out to individuals.

So, no....this would not be a smart thing to do, in spite of your motives being altruistic.

I am not a nurse but I worked in a pharmacy for many years and this is considered insurance fraud. Both you and the doctor could get in a lot of money. Don't worry about the patient's money, that is not your problem. They're obviously not concerned about your license.

lol sorry correction, a lot of trouble (not money). hmmm.. wonder where my mind is wandering?

Specializes in Post Anesthesia.

Short on time so I didn't read through all the responses but here is my 2cents. If the prescribed dose (the double dose) is within the normal prescribed strength and frequency for thier problem, and would be safe if the patient to whom it was prescribed could take the entire prescription alone safely, I don't see a problem. Yes, there is some ethical and legal grey area here, but as long as the physician is aware of the dose he is ordering and why, I would hope he would at least consider the $$ implications of the situation.

Specializes in PICU, NICU, L&D, Public Health, Hospice.
i wonder if 2 prescriptions were taken to a pharmacy such as heron suggests, at the same time, if the pharmacy would charge for the total number dispensed rather than charge for each bottle? this would be something for the patients to ask their pharmacist.

is the medication something the patients take continuously? do they get 90 days' worth at a time or another large amount? do they get it through the mail? i'd be concerned that one or the other patient wasn't getting appropriate followup related to the medication, if it's prescribed as the patients want it to be prescribed. would they alternate who gets his name on the prescription next time? would the record show who got what? there are so many complications that could come up in this.

i'm also concerned about you writing the prescriptions and having the doctor sign them. what if you misunderstood what the doctor said? what if you make an error and the doctor doesn't catch it when he signs it, or doesn't read what you wrote carefully? what if something goes wrong? i'm not sure you writing the prescriptions is legal. i think at the least it's questionable.

i think that, in general, this is a bad practice...writing prescriptions that physicians sign. having worked in the community and primary care setting, i think that those persons with prescription privileges should write their own rxs. it is the safest and most direct execution of their orders. i feel that the more direct writing of orders was also more appropriate in the acute care setting. even in the icu, with the exception of emergent situations, it was heavily encouraged that the nps and mds physically wrote their own orders.

i also think that, in specific, it may occasionally represent the most efficient practice. i currently work in hospice and it is simply not possible, many times, for the prescribing md to write the rx as a primary form of that communication.

you ask some great questions. i think that rns in the primary care setting really try to follow their patients for those things. you know...the routine visits, lab follow ups, disease specific screenings, immunizations, yada, yada, yada. i know i did, and i would bet most of my peers did as well.

i honestly believe that the trend to remove the rn from the primary care setting in favor of less expensive support staff has measurably harmed the health of our citizenry.

Specializes in Peds/outpatient FP,derm,allergy/private duty.
Y'all are endlessly paranoid!:smokin::smokin::smokin::smokin::smokin:

Let the doc know you aren't comfortable and let them either write it themselves or decline the request. It will be on the MD. You give info and they made the decision and wrote it so there is no way you would be liable.

And remember that if there is no harm there is no law suit.

Your risk of getting in trouble is 1 million times higher for not documenting proper follow up for a abnormal lab result that results in a worsening condition. I wonder how many times that happens in your office?

She can give it to the doctor to decide how to proceed, but if he/she agreed with the plan he would need to falsify the medical record as it must match what he wrote out on the prescription. If he didn't, it would look on paper as if he was not prescribing patient A with something clearly indicated for his condition, and look like he was prescribing patient B with double the indicated dose. I can't imagine any doctor agreeing to do that. What if the patient who "on paper" is not getting the drug has an adverse reaction? What if one of them calls the pharmacist to ask a question about side effects? What if a different doc in the group gets a call and is changing doses based on the belief that patient B is taking 100mg of something when the doc really meant she should take 50mg?

I don't think that's being overly paranoid at all. If a prescription is meant for one person and it's cheaper to write for the higher dose and instruct "take 1/2" it is totally different.

My personal PCP writes out her own scripts, but any surgeon I've ever worked for always had me write out the scripts. They would sign anything I put under their noses. Further, they didn't want to be bothered with refill requests or initial call-ins for new scripts. And to be honest, it was better that way: I have caught more than one MD in a very wrong dose or sig. in my experience, most surgeons just don't want to be bothered with remembering dosages, quantities, instructions, etc.

We normally handled refill requests and calling in new prescriptions, too. I don't think there were more than 5 times total that a doc actually spoke to the pharmacist him or herself, and that was usually because the pharmacist was a butt and insisted. You know the type. Lowly nurse not smart enough to talk about that stuff. Thankfully there are few of those. :rolleyes: I worked in family practice, dermatology and allergy - only minor surgeries. Thanks for answering that for me, though! I always tried to have the doc's back as well, it just didn't extend to the actual writing out of the initial prescription.

Specializes in Family NP, OB Nursing.

First, I don't think it's ever a good idea for a provider to simply sign "whatever I put under his nose". It's just not prudent at all in my opinion. I do think it is fraud, but I would have no problem writing for double the dose with instructions to take half each day if it was safe for the medication. Some medications cannot be split safely due to shape or because of the way the medication is delivered, such as enteric coating or delayed release meds.

So, assuming the med can be safely cut in half, I would write 2 prescriptions, one for Mary and the other for Bob; same med, double the dose with instructions to take half daily. Overall, this accomplishes the same thing as prescribing only for one of them, since they'd have to get the medication refilled less frequently.

It may actually be better since many insurance companies only allow a certain number of pills/day, based on a usual dose. So if the max daily dose of the med is 200 and they are each taking 100, I'd only be able to write for 30/month anyway.

In any case, the original poster should NEVER take it on themselves to change an Rx just based on the patient request knowing the doc will just sign it. I find that COMPLETELY wrong. If she discusses it with the doc and he decides it's okay, then it's on him.

Also, I have no problem with RNs calling in refills, but only after I've reviewed the refill request and given it the OK. Sometimes there are labs that need done, or the patient needs a follow up appointment.

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