Sign prescription for MD?

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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.

On 2/4/2020 at 2:05 PM, TXERRN84 said:

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

I found an article earlier today about a doctor who was accused of professional misconduct for having his nurse sign HER name. Not the same, but I found it interesting. I don't know how to upload the link. Now in THIS case, the nurse was protected. It appears in the eyes of the court to have been viewed the same as the nurse transcribing an order.

However, signing the physician's name is straight up forgery. And if caught the doctor could easily cover his own but and try and claim he knew nothing of nurses signing his name. I personally think your coworkers would be toast ? This is a hill I would die on a thousand times if management doesn't have your back on this.

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

Standard education below provided in my initial nursing program and Home Health infusion company+ hospice inservices. When I became a Home Health Central Intake Manager (providing infusion services), my department responsible for ensuring all prescription orders met state and federal regulatory standards. Had to hunt to find Texas pharmacy law re valid prescriptions.

Along with providers printed name, business address, medication order, the prescribers state license number, NPI (National Provider Identification number) must be listed on prescription; when narcotic ordered, must include prescribers DEA (drug enforcement administration) number. Karen

Explanation How to Write a Prescription

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Prescriber’s Sign on the Written Prescription

Your sign is a must-have part of the prescription. Your signature makes the prescription valid and reliable. You can use the bottom of the page to sign the prescription if there is no separate space or specific line for the signature.

Make your signature the last part of your prescription writing practice. This ensures no one can misuse the blank and unfinished prescriptions.

https://www.aresearchguide.com/write-a-prescription.html

Overview of Texas Pharmacy Law

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Prescriptions filled in Texas for non-controlled substances are valid for one year from the written date, and may only be refilled within this time frame. ...

Prescription requirements in Texas

Prescriptions filled in Texas must meet the following requirements:

●Prescriptions must be written by a prescriber with prescribing authority in Texas as noted in the chart in the previous section.

●Written prescriptions must include the prescriber’s actual signature; an electronic signature can be used if the electronic system replicates the prescriber’s actual signature and if printed on paper designed to prevent alteration of the prescription.

●Written prescriptions for controlled substances require a manual signature and the prescription must be written on an official prescription form as required by the Texas Controlled Substances Act.

●Oral prescription orders may be called in to the pharmacy if the pharmacist or intern under the supervision of a pharmacist reduces the prescription to writing immediately.

●Prescription orders may also be sent by the prescriber’s office via fax or email.

https://s3.amazonaws.com/EliteCME_WebSite_2013/f/pdf/RPTX01TLI15B.pdf

Reference: Texas Occupations Code Chapter 552: Texas State Board of Pharmacy.

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Specializes in Medsurg.

Girl dont be like them other fools signing it. Dont do it

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

Texas: Forging physician signature

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Taking Texas as an Example

Altering or forging a prescription is a class B misdemeanor for a first-time offense. The statute notes that it is a crime to either forge a signature or change the prescribed quantity of a "dangerous drug" in a prescription. Using a forged or fictitious prescription in any manner is a punishable offense in Texas, whether obtaining drugs by phone or in person. Issuing a false prescription is also a crime.

https://blogs.findlaw.com/blotter/2015/11/penalties-for-forging-a-prescription-for-drugs.html

Texas Health and Safety Code § 483.045. Forging or Altering Prescription

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(a) A person commits an offense if the person:

(1) forges a prescription or increases the prescribed quantity of a dangerous drug in a prescription;

(2) issues a prescription bearing a forged or fictitious signature;

(3) obtains or attempts to obtain a dangerous drug by using a forged, fictitious, or altered prescription;

(4) obtains or attempts to obtain a dangerous drug by means of a fictitious or fraudulent telephone call;  or

(5) possesses a dangerous drug obtained by a forged, fictitious, or altered prescription or by means of a fictitious or fraudulent telephone call.

(b) An offense under this section is a Class B misdemeanor unless it is shown on the trial of the defendant that the defendant has previously been convicted of an offense under this chapter, in which event the offense is a Class A misdemeanor.

https://codes.findlaw.com/tx/health-and-safety-code/health-safety-sect-483-045.html

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A Class B misdemeanor in Texas can result in:

  • Up to 180 days in jail
  • Fines up to $2,000

https://www.dallasdrugcrimesattorney.com/drug-crimes/prescription-fraud/forging-or-altering-prescription/

Hope this discussion is helpful to all nurses, especially ED and outpatient nurses. Please let us know outcome of this issue.

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Specializes in Nurse Leader specializing in Labor & Delivery.
15 hours ago, TXERRN84 said:

I think so too- I was trying to find hard proof of that somewhere. I couldn’t find it on the Tx BON site

Probably because it’s so ridiculous and egregious that they didn’t think it necessary to spell out. I bet “Don’t smother your annoying patients with a pillow” is not written anywhere on the BON’s website either.

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10 hours ago, Orion81RN said:

I found an article earlier today about a doctor who was accused of professional misconduct for having his nurse sign HER name. Not the same, but I found it interesting. I don't know how to upload the link. Now in THIS case, the nurse was protected. It appears in the eyes of the court to have been viewed the same as the nurse transcribing an order.

However, signing the physician's name is straight up forgery. And if caught the doctor could easily cover his own but and try and claim he knew nothing of nurses signing his name. I personally think your coworkers would be toast ? This is a hill I would die on a thousand times if management doesn't have your back on this.

Screenshot_20200205-220248_Adobe Acrobat.jpg

I am very curious as to how the pharmacy filled any of the prescriptions when they don't bear the signature of someone with prescribing authority. We have generic pads when I run out of the ones with my info on it...if I get into a hurry and the pharmacist can't figure out who wrote it? The patient calls the office and tells us the pharmacist won't fill it.

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Specializes in ER.
15 hours ago, JKL33 said:

Yes, and I don't know what my peers were doing and don't care, but as for me I was writing it in the chart as an order along the lines:

"Discharge Rx: [Blah, blah, blah, whatever the doctor told me] VORB/[Dr. Name/my sig]" and it was eventually co-signed.

It’s just a ridiculous pain in the butt instead of having someone just sign their own name!

1 hour ago, Jory said:

I am very curious as to how the pharmacy filled any of the prescriptions when they don't bear the signature of someone with prescribing authority. We have generic pads when I run out of the ones with my info on it...if I get into a hurry and the pharmacist can't figure out who wrote it? The patient calls the office and tells us the pharmacist won't fill it.

Yes I saw that a article! But like you said she wasn’t forging his name at least!

1 hour ago, klone said:

Probably because it’s so ridiculous and egregious that they didn’t think it necessary to spell out. I bet “Don’t smother your annoying patients with a pillow” is not written anywhere on the BON’s website either.

? you would think it’s a no brainer right?!

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Specializes in ER.
10 hours ago, NRSKarenRN said:

Texas: Forging physician signature

Texas Health and Safety Code § 483.045. Forging or Altering Prescription

Hope this discussion is helpful to all nurses, especially ED and outpatient nurses. Please let us know outcome of this issue.

Wow thank you for all of that!!!

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Specializes in ER.
On 2/5/2020 at 8:23 PM, Jory said:

You don't need to find it on the BON website because in school nurses should have been taught you NEVER sign for the MD without adding your name. Ever. End of story.

The DEA is the one that will put you in prison...not the BON. They will bypass that whole operation.

I would pull up your disciplinary actions. You won't have to read too far before you'll find nurses that have been suspended for doing exactly that.

Yes it seems like a no brainer!

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Specializes in ER.
On 2/5/2020 at 7:45 AM, Jory said:

Not legal. You can call in a prescription, but in terms of actually WRITING them? Uh...no. You'll be putting your license on the line if they are opiates.

Question: How are these getting filled by the pharmacy? Most pharmacies will reject with a signature that reads Dr. John Smith/Karen Jones, RN

If people are SIGNING HIS NAME? That is what you call a forgery and not only can you lose your license, you can go to prison.

Yes they are signing his name only- not writing their name at all

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1 hour ago, TXERRN84 said:

It’s just a ridiculous pain in the butt instead of having someone just sign their own name!

Yes, your scenario is over the top for at least a few reasons. The forgery, the laziness, the lack of even a compelling reason for any of it, etc.

At the time my scenario was single-coverage in ED that wasn't very sleepy at all. The docs tried, but with some small frequency things were overlooked/forgotten and they would be truly be in the middle of something else when it was discovered or remembered that they had told the patient they were going to prescribe something. They were running all shift long. I could've simply had the patient wait for them to finish a 30-minute suture job (for example), but that didn't seem right either, so I tried to make the best of it at the time by trying to follow basic principles.

The story would be entirely different if they had been kicked back watching TV. ??

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When you come across something like this that you know is wrong, there's no reason to really even waste time asking around about it or worrying about it. Just straight up say no. I've had full-on stand-offs over a couple of things, a wacked-out consent procedure was one of them. Simple when you know you have the upper-hand: "You are welcome to do that if you wish. I will not. Because it is illegal." ??‍♀️

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