Sign prescription for MD?

Nurses General Nursing

Updated:   Published

At my new position in an ER it is apparently common practice for one particular MD to not sign his own prescriptions. He leaves it blank and expects the RN to sign it. Is this legal in TX? I’ve never seen this done at any other ER.

I was familiar with a place where something like this was common. In that instance they were writing out the prescription then signing with [physician's name/Nurse signature]. When I asked questions/informally protested their rationale was along the lines of why I would think this is entirely different than taking a verbal order ("So you have no problem writing an order in a chart, applying the physician's name to it and then signing your signature--which is also a prescription?").

So, I simply wrote the verbal order on the RX just like I would in a chart, and on the sig line I wrote "VORB Dr. X/[my sig]." I never heard anything more about it and eventually the whole practice went away. It was before prescribing/e-Rx was integrated into the EMR. I didn't feel wrong about this because I always documented this in the chart so there was a proper record of it, and only ever wrote out prescriptions that were indeed told to me as verbal orders.

I wouldn't give the appearance of signing anyone's signature, which is to say...forging it. That was the line I wouldn't cross.

Just go to your manager and say you're unable to do x, y, z. They may take care of the problem for you; I have a decent guess they don't know this is going on.

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Specializes in ER.
21 minutes ago, JBudd said:

Good Lord! NO!

You can take verbal orders, and they are written as verbal or telephone orders with your name and the MD's; but it still has to be cosigned whether electronic or on paper.

As said above, signing his name (without yours) is forgery.

So is it allowed for an RN to sign their name and write the MD's name?

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Specializes in Vents, Telemetry, Home Care, Home infusion.

A physician can not delegate signing medication prescription form, especially if scheduled narcotic. That is a violation of federal and state laws.

Federal Law: SECTION IX – VALID PRESCRIPTION REQUIREMENTS

https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

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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.

Texas Regs:

Quote

the signature of the prescribing practitioner, unless the prescription is called into the pharmacy

http://tmb.state.tx.us/page/renewal-prescribing-updates

This issue needs to be reported to both Nurse Manager, ED Medical Director and risk management for fast resolution.

RN's signing physicians name on electronic printed prescription prescriber entered into EMR is forgery. RN's can't sign VO DR so and so/ RN signature as done in inpatient setting as that requires physician sign off of order.

This practice needs to STOP. I'm surprised pharmacies haven't questioned variations in physician signature on RX presented to them. Both physician and nurses could be brought up for charges by medical and nursing boards --- better believe physician will throw nurses under bus "didn't know RN's signing my name."

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Specializes in ER.
On 2/3/2020 at 12:19 PM, NRSKarenRN said:

A physician can not delegate signing medication prescription form, especially if scheduled narcotic. That is a violation of federal and state laws.

Federal Law: SECTION IX – VALID PRESCRIPTION REQUIREMENTS

https://www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_content.htm

Texas Regs:

the signature of the prescribing practitioner, unless the prescription is called into the pharmacy

http://tmb.state.tx.us/page/renewal-prescribing-updates

This issue needs to be reported to both Nurse Manager, ED Director and risk management.

Thank you so much- does all of this only apply to controlled substances?

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The doctor needs to be told to come back and sign them, no way would I sign them. I hope you have !

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Specializes in ER.
2 hours ago, DeeAngel said:

The doctor needs to be told to come back and sign them, no way would I sign them. I hope you have malpractice insurance!

Yeah I have never done it! I think it's crazy- was just wondering if anyone else had ever heard of it.

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Specializes in NICU/Mother-Baby/Peds/Mgmt.

No, this would apply to ALL prescriptions. Surely there's a way for the doctor to print out his prescriptions seperately and sign right then and there. Call IT if no one knows how to do it, they can either tell him and you how to do it or change the program. Make sure the doctor knows how to do it otherwise you'll run into the "she wasn't around and I didn't know how to do it" problem. They made it through med school, they can remember how to print a document.

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No, forgery is not legal. No, impersonating a physician by acting as one is not legal. No, you don't have to break the law to avoid ruffling feathers. His laziness is not your problem. Let me just tell you how this story ends the first time one of his patients has an adverse reaction to a prescription that you forge on his behalf... HE won't be the one who is thrown under the bus.

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Specializes in ER.
1 hour ago, FacultyRN said:

No, forgery is not legal. No, impersonating a physician by acting as one is not legal. No, you don't have to break the law to avoid ruffling feathers. His laziness is not your problem. Let me just tell you how this story ends the first time one of his patients has an adverse reaction to a prescription that you forge on his behalf... HE won't be the one who is thrown under the bus.

That is exactly what I'm thinking- I brought it to the attention of someone and am waiting to hear back about it. Thank you.

2 hours ago, Elaine M said:

No, this would apply to ALL prescriptions. Surely there's a way for the doctor to print out his prescriptions seperately and sign right then and there. Call IT if no one knows how to do it, they can either tell him and you how to do it or change the program. Make sure the doctor knows how to do it otherwise you'll run into the "she wasn't around and I didn't know how to do it" problem. They made it through med school, they can remember how to print a document.

Thank you- it literally prints out 3 feet from his desk- he just doesn't feel like it, so now "everyone" just does it for him and I'm a weirdo because I don't want to and I'm not going to.

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Specializes in Assistant Professor, Nephrology, Internal Medicine.

I think it may even be considered a federal offense to sign the mds scripts. You’d likely get in more trouble than they would.

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Specializes in ER.
1 hour ago, Bumex said:

I think it may even be considered a federal offense to sign the mds scripts. You’d likely get in more trouble than they would.

That is exactly what I'm thinking- thank you so much.

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Specializes in Psych, Corrections, Med-Surg, Ambulatory.

Lordy, I can't believe nurses are going along with this. One bad reaction or someone starts looking into his prescribing habits and he can play ignorant. You know how we're always telling people not to be so afraid of losing their license? If you're going to participate in this practice be very afraid.

I'm glad you've reported this up the chain of command. Someone needs to stop this game. Bummer it had to be you and kudos to you for stepping up.

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