When the physician ask you to help sign schedule II drugs for him/her

[Kay-teeRN]

I am a new nurse practitioner working my first job in California. I am still on orientation but helping with faxed schedule II authorization forms from SNIFF facilities where our patients are. Myself and three other NPs help sign these daily faxed schedule II drugs authorization forms. My preceptor who is a NP said we do this to help the supervising physician out because he is super busy. I have no idea who the patient or why they are taking these medications. My supervising NP stated that its okay because he's supervising us and his name and DEA is also on the form.

Basically the form is filled out by the nursing facility or whomever and the form comes to us addressing the doctor but as his NP we can sign it for him. I sign it by putting my name and DEA number.

With that being said, I just wanted to know by signing my name and dea I am furnishing the drug and not the doctor and if something happens it will be on me and not the physician?

[SnowShoeRN]

I can't advise you from a legal standpoint, but I would personally feel very uncomfortable doing that. At my last practice, we would get drug authorization forms come in and my my supervising MD was adamantly AGAINST us signing for each other. She was of the opinion that if our name was not on the original prescription, we didn't know the pt or their circumstances to sign the authorization. And that wasn't even including schedule II's. Maybe someone here with more experience can advise? Best of luck.

[Corey Narry, MSN, RN, NP]

Not a legal expert here either but a few thoughts come to mind:

- prescribing or in our case, "furnishing" must be done as part of a provider-patient relationship and documentation of this encounter must be present.

- at times, providers within a medical clinic or practice will refill prescriptions for patients within that practice as in the case of a provider who is covering for a colleague who is unavailable. In some of these instances, there is no face to face encounter as the visit was already established and the reason for the prescription was already documented.

- as NP's working under a supervising physician, as is the case in California, the supervising physician is also liable for your actions based on the concept of "respondeat superior". However, we also carry liability as we have our own license.

- the setting you are working at is not the community where patients pick up their prescriptions from a pharmacy and take them as instructed. These are SNF patients whose medications (including CS) are administered by nurses via an order written by a provider.

Having said these, I would bring this up to your malpractice provider and ask for their opinion as far as your risk.

[DrZaphod, BSN, MSN, DNP, RN, NP]

Definitely don't do that. You are superior to the physician based on years of research. I would never sign some drug that I didn't Rx. He is supervising no one. I pay my "supervisor" $200 per month and he's never met a patient of mine. Perfectly legal. The nursing board will not be pleased if you randomly sign off on some physician's work. "Too busy." What does that mean? Retire, then. Open your own practice, NP.

[traumaRUs, MSN, APRN]

What Juan said. I live in IL and Rx Class IIs - however it is required (as it should be IMHO) that I make a note in the pt chart that I have seen/spoke with/assessed the pt and continuing need for the med. This helps all providers know what/why a pt is taking a med.

[Jmartin2376]

I would call the BON and inquire....

[JellyDonut]

Yikes! So, you sign your name for schedule II drugs on a patient that you have never seen or examined? When these questions come up I always think about how this would look under deposition. So many red flags come up. Suppose, god forbid, something goes wrong or you sign for a wrong dose (as you say the NH fills these out) and the patient has an adverse response. The physician could easily deny any wrongdoing and who do you think is liable? I would not ever sign schedule II meds on a patient I have not seen or examined. Other meds like antibiotics, yes I have but never schedule II - but I agree with above, contact your BON or maybe even the DeA for clarification .

[kbdeleon]

I think context is everything. Does your license allow you to prescribe schedule 2 substances within that type of facility, as provided under state and national law? Does the doctor have a documented treatment plan he wants you to follow? Have you examined the patient yourself? Is the prescribing as a collaborative practice or are you allowed to independently prescribe in your state? In that situation would the BON hold you or the physician accountable (i.e. are you prescribing as a substitute prescriber in his absence or are you following a verbal order to dispense a medication or are there considerations for prescribing by proxy in applicable law). You could ask the physician for more clear wording regarding schedule II substances in a collaborative agreement and assign a clear responsibility for the prescribing and then present the agreement to the board of nursing and see what they have to say about proxy prescribing. Consulting your malpractice insurance would be a good idea as well.

[Goldenfox]

Let him sign his own schedule II drugs.

[LadysSolo]

Unless it needed refilled and I was covering (say it was the MD's weekend off and I was taking call) I would not sign, and if it was the weekend I was covering I would only give enough to get till Monday. I want to see anyone I am giving a Schedule II med to, even if just briefly, for documentation purposes. Even antihypertensives, cardiac meds, anything, I want to know something about the person before I refill. Circumstances and people change, they may need a lower or higher dose, or may not need it at all (think polypharmacy.) I take prescribing VERY seriously.