Issues that May Arise with Prescriptive Authority of Controlled Substances
Many states are moving toward making changes to existing laws regulating the scope of practice for Advanced Registered Nurse Practitioners (ARNPs) to include independent prescribing authority. Independent prescribing authority refers to the ability to prescribe controlled medications without collaboration with a physician. This is a key component of APRN scope of practice, and an important part of the APRN Consensus Model. Prescription of controlled substances represents significant risks, and understanding these risks is critical in order to provide safe and effective patient care. A primary concern centers on prescription opioid use disorder, affecting patients, health care providers, and the community at large (Chedekel, 2015).
Health professionals who prescribe or handle controlled substances are required to know the Controlled Substance Act regulating practice. This includes knowledge of the schedule of controlled substances, the risk and prevalence of a substance use and addiction disorder, and the treatment guidelines for prescribing controlled substances as well as prevention of prescription drug abuse and misuse. Patient assessment and evaluation of outcomes related to the treatment plan, including a prescriber-patient opioid agreement, are necessary skills for providers prescribing scheduled drugs (Chedekel, 2015).
When it comes to preventing misuse of controlled substance and the risk of a substance use and addiction disorder, we as future APRNs with prescriptive privileges can follow several clinical practices and prescribing practices that can minimize or prevent these consequences. Most importantly, it is essential to understand drug Schedules and to know which drugs are classified according to the Schedules of Controlled Substances. We must also be familiar with the laws and guidelines surrounding prescription of substances within each Schedule (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).
When writing a prescription, the provider should write the script legibly to reduce the risk for forgery of the document. Sloppy or illegible writing of a prescription can result in a patient or another person altering the dose or number of pills without it being noticed. Because the drugs within Schedule II/IIN require written prescriptions, protection of the actual prescription pad is essential to prevent theft. By keeping it locked up and in a safe place, it is less likely to be stolen and used to forge a prescription for a controlled substance. In cases where electronic prescriptions can be written instead of paper prescription pads, the provider should try to write an electronic prescription or use e-prescribing software to reduce the risk of forgery and falsification (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).
A nurse practitioner who prescribes controlled substances needs a DEA number associated with a license to practice. The provider should monitor the DEA number to ensure that no one else has tried to use it and that prescriptions written associated with that number were only written by the provider. Often, pharmacists and pharmacy technicians can check a prescriber’s DEA number through the database to verify prescriptions and to determine whether a prescriber has been prescribing controlled substances appropriately. In understanding policies regarding number of refills allowed according to each Schedule, the prescribing provider should follow these guidelines closely, educating staff and colleagues about policies for refills, if necessary (“Florida Board of Nursing » Important Legislative Update regarding HB 423 – Licensing, Renewals & Information,” n.d.).
When considering whether a specific patient needs a prescription for a controlled substance, the nurse practitioner can also potentially prevent misuse and substance abuse by performing thorough patient examinations that assess the patient’s medical history, history of substance use and abuse, and assessing for patient pain levels. The types and amounts of concomitant medications the patient is taking should also be documented. When possible, alternative therapies, including those medications that are not controlled substances or nonpharmacological adjuvant therapies should be employed instead. In extreme circumstances, such as when the patient is acutely intoxicated with a controlled substance or demonstrating an inability to safely utilize a prescription for one of these drugs, the prescribing provider should consult with a specialist for substance abuse treatment and avoid writing the prescription for the controlled substance (Chedekel, 2015).
Issues that May Arise with Prescriptive Authority of Controlled Substances
The prescription of controlled substances by nurses is often one of the controversial issues that leads to the revoking of licensure only after the realization of already damaging effects of the same. The CS/CS/CS/SB 614, for instance, is a Florida 2015 law that grants APRNs the freedom to administer, dispense, or prescribe any drug including the controlled substances such as opioids (The Florida Senate, 2020). One of the issues that may arise from this prescriptive authority is the delegation of these duties by APRNs to other individuals or lack of direct examination of the patients before administration, which may lead to licensure revoking (Osborne, 2017). In the case of Heather Alfonso, a Derby APRN, her licenses were revoked and was almost imprisoned for three years for misusing her freedom of prescribing controlled substance (Chedekel, 2015). From the report about Alfonso, there was evident that she would prescribe patient medication even without proper examination by a licensed healthcare giver, and this led to many patient abnormalities until she was noticed (Chedekel, 2015).
How One Can Avoid these Situations
One can avoid these issues by performing comprehensive patient examination before any prescription activity. Also, there is need to follow the strict regulations of using these controlled substances, such as using some of the opioid medications only in the cancer treatments of pain (Soelberg et al., 2017). Lastly, a healthcare giver should always consult extensively if they are unsure that some of the medications they are giving to the patients are the best alternatives.
above is the original homework in case you needed:
CS/SB 614 authorizes an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.
ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include:
Presigning blank prescription forms.
Prescribing a Schedule II for office use.
Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions.
Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance.
Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice.
Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice.
Prescribing, dispensing, or administering a controlled substance to himself or herself.
Prescribing, dispensing, or administering laetrile.
Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act.
Promoting or advertising controlled substances.
After reading the following news article http://c-hit.org/2015/04/06/high-prescribing-nurse-surrenders-drug-licenses/
Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations?