Who prescribes for themselves or family

[automotiveRN67]

I started this conversation with a group last week, and thought I would continue it here.

How many of you prescribe for yourself, or family or friends?

How long have you been practicing?

[traumanightsRN, NP]

It's technically illegal to prescribe for someone who is not a documented patient. You can lose your license.

[Jules A, MSN]

Yes, but in this case he was prescribing controlled substances to himself and his girlfriend. He was not real smart.

Foolish for sure but I'm not sure really why the differentiation. Why would it be ok if it was an antibiotic instead? I'm not arguing in favor of doing it, like I said I don't prescribe for myself or family but just wondering why the difference. If its wrong to prescribe for self or family I would think it shouldn't matter what the product.

[edmia, BSN, RN]

Well, again I have to say "use common sense". It seems this case was really about the supervising physician not standing up for her in this case. Obviously, she examined her son and used due-diligence when deciding on prescribing the antibiotic.

But, what you have said certainly serves as a warning.

The problem is also that NPs are limited by random legislation on their true scope of practice. In my state, I don't need a physician to sign off on my clinical judgement, so this would not be a scenario that I fear.

Sent from my iPhone -- blame all errors on spellcheck

[PG2018]

Foolish for sure but I'm not sure really why the differentiation. Why would it be ok if it was an antibiotic instead? I'm not arguing in favor of doing it, like I said I don't prescribe for myself or family but just wondering why the difference. If its wrong to prescribe for self or family I would think it shouldn't matter what the product.

I know you're not in favor of self-prescribing, but I'm in line with this method of thinking. I don't see how anyone could be upset about prescribing Augmentin for OM with the appropriate criteria. What accusation could one make? However, I could easily see some pharmacist or bureaucrat jumping up and down after prescribing a personal acquaintance Percocet, Adderall, or Xanax in the line of "Oh, you're just facilitating their addiction. And you're probably taking some yourself!"

[PG2018]

The problem is also that NPs are limited by random legislation on their true scope of practice. In my state, I don't need a physician to sign off on my clinical judgement, so this would not be a scenario that I fear.

My state still has a collaborative practice arrangement requiring a QA plan, yet the physicians don't really dictate meds. Generally, an agreement is written that basically says "you'll prescribe in line with your board certification and/or training." I guess some unfortunate people could have more restrictive ones with specifics like use X then Y followed by Z. There's no stipulation regarding who/how/where. I think most PAs, unfortunately, have a protocol-based practice.

[edmia, BSN, RN]

The more exposure I've had in my graduate program to clinical practice, the more cautious I've become. Prescribing is not just about finding the right med on some resource book or app. It's a huge responsibility and liability of course. I'm still thrilled about the advance role and thank myself for deciding on grad school everyday as I never, ever want to go back to bedside.

Loving this discussion. It's great to see the different perspectives.

Sent from my iPhone -- blame all errors on spellcheck

[Jules A, MSN]

I know you're not in favor of self-prescribing, but I'm in line with this method of thinking. I don't see how anyone could be upset about prescribing Augmentin for OM with the appropriate criteria. What accusation could one make? However, I could easily see some pharmacist or bureaucrat jumping up and down after prescribing a personal acquaintance Percocet, Adderall, or Xanax in the line of "Oh, you're just facilitating their addiction. And you're probably taking some yourself!"

But why bother when I can easily text someone and be like "dude call in some augmentin for me"?

Since it doesn't seem cut and dry I am not willing to take the chance. I don't see how this would fly. If the board deems we are responsible and legally able to prescribe to self what would make our judgement not be fit to prescribe whatever our license allows?

[Jules A, MSN]

From Carolyn Buppert:

Medscape: Medscape Access

Medscape: Medscape Access

I also know a physician who was suspended for a period of time for prescribing to self and his girlfriend. Quick google search from the Maryland physician's site. Not nursing but I model myself after physicians and it would make sense to me if they aren't allowed to do it we shouldn't be either:

Suspension for an additional period of a minimum ofone year. The Board suspended the physician for an additionalyear for violating the Consent Order of February 2,2011, and for admitting to using CDS and self-prescribingCDS. Date of Action: April 2, 2012

Clarification: The snipppet I added from the physician's board is not the same case as the dude and GF I knew. I have confused myself by adding 3 separate thoughts in one post. Sorry.

[automotiveRN67]

My state still has a collaborative practice arrangement requiring a QA plan, yet the physicians don't really dictate meds. Generally, an agreement is written that basically says "you'll prescribe in line with your board certification and/or training." I guess some unfortunate people could have more restrictive ones with specifics like use X then Y followed by Z. There's no stipulation regarding who/how/where. I think most PAs, unfortunately, have a protocol-based practice.

I'm the same. My protocol says "what" I can prescribe, but it doesn't dictate to "whom" or "where".

[Psychcns]

I have never seen or heard of a BON, place of employment etc saying it is OK.. They may not address it.. Not sure if this is enough. Ask your malpractice carrier.

[PG2018]

But why bother when I can easily text someone and be like "dude call in some augmentin for me"?

Since it doesn't seem cut and dry I am not willing to take the chance. I don't see how this would fly. If the board deems we are responsible and legally able to prescribe to self what would make our judgement not be fit to prescribe whatever our license allows?

I don't really care who prescribes to who. I see the boards and regulatory agencies taking an offense to prescribing controls although they're obviously taking offense to taking offense to legends as well. However, I do not personally see the offense. I think once we're vested with prudently prescribing then there should not be a limitation.

I envy your ability to text someone and get that. I feel like my collaborating doc would do it for me, but It's never come up.

[Jules A, MSN]

I don't really care who prescribes to who. I see the boards and regulatory agencies taking an offense to prescribing controls although they're obviously taking offense to taking offense to legends as well. However, I do not personally see the offense. I think once we're vested with prudently prescribing then there should not be a limitation.

I envy your ability to text someone and get that. I feel like my collaborating doc would do it for me, but It's never come up.

Yeah I hear ya and don't care about a lot of stuff but the BON scares me with their vague rules and ability to snatch my livelihood for whatever they might deem in appropriate. Plus I'd rather surrender my license for something I had no clue I was doing wrong and not something I should have figured probably isn't a great idea.

Keep getting to know the local providers, maybe start with a PCP? In general others are curious about psych which makes initial conversation a breeze. People here probably get sick of hearing me say it but I swear the professional contacts I have made and nurtured over the years have served me well on so many levels. Its like high school if one Doc likes you and introduces you to another Doc you are in.