E2 Lecture 12 Flashcards
What is a prescription?
An order for a medication which is dispensed to or for an ultimate user but does not include an order for medication which is dispensed for immediate administration to the ultimate user
A written order for oxycodone tablets to be dispensed directly to a
patient – prescription
A written order for diazepam to be administered by a nurse to a patient – not a prescription (a drug order, covered separately)
Controlled Substance Prescription Issuance
Can only be done by practitioners authorized to prescribe
Controlled substance prescribers must have a DEA number or be exempt from registration
Only after a prescription is issued by a prescriber may it be communicated to a pharmacist by an agent of the practitioner
Importantly, agents cannot communicate C-II emergency prescriptions, as the DEA notes a prescriber cannot give agency to anyone for this type of prescription
Responsibilities of Issuing a Prescription
A prescriber must ensure prescriptions are “issued for a legitimate medical purpose by a practitioner acting in usual course of practice.”
Legitimate medical purpose: patient has a medical need for the medication
Usual course of practice: prescriber has a valid patient-provider relationship
This used to require at least one in-person patient evaluation, but since COVID-19,
this has included telemedicine visits
The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.”
Corresponding Responsibility
Pharmacists are accountable in making sure controlled substances are prescribed and dispensed appropriately
Must have knowingly filled a fraudulent prescription to violate the law: Knowingly means that pharmacist recognized the possibility of wrongdoing but refused to conduct a proper investigation
DEA list of Potential concerns
- Prescriber writes more prescriptions than other prescribers
- Prescriber writes for larger quantities than other prescribers
- Patient attempts to fill their prescription too frequently
- Prescriber writes for antagonistic drugs at the same time
- Patient presents prescriptions written for other people
- Multiple patients attempt to fill prescriptions at the same time from
the same prescriber - Patients who don’t regularly use your pharmacy and are not members of your community present prescriptions from the same prescriber
- Prescription looks “too good,” perfect handwriting
- Quantities, directions, or dosages differ from usual use
- Prescription does not utilize standard abbreviations
- Prescription appears to be photocopied
- Prescription is written in different inks or different handwriting
Refusal to fill a controlled substance
When documenting issues, it is important not to deface the prescription, as that is the property of the patient.
If you determine not to fill a prescription, the prescription should be returned to the patient, unless the prescriber asks you to destroy it.
With electronic prescriptions, you may need to call the provider and tell them
to send the prescription to another pharmacy
Use your professional judgement when determining whether to fill a controlled substance, and document your rationale for filling or refusing to fill a prescription
C-II prescriptions may be dispensed if
- A written, paper prescription signed by the prescriber
- An electronic prescription transmitted by the prescriber
- A fax prescription, if the patient presents the manually signed prescription to the pharmacist prior to dispensing
Acceptable C-II Faxed Original Prescriptions
Injectable (narcotic)
LTCF
Hospice (narcotic)
Schedule III, IV, V
C-III, C-IV, C-V prescriptions may be dispensed if
- A written, paper prescription signed by the prescriber
- An electronic prescription transmitted by the prescriber
- A fax prescription transmitted by the prescriber or the prescriber’s agent
- A telephone prescription promptly reduce to writing by the pharmacist
Controlled Substance Prescription Quirks
Any C-II through C-V may be dispensed or administered without a prescription by an individual prescriber
Institutions may administer or dispense (not prescribe) C-II through C-V drugs based on a prescription or order from an individual practitioner if it is dispensed for immediate administration to the
ultimate user
Required Information for Controlled Substance Prescriptions
- Date the prescription was issued
- Full name and address of patient
- Drug name, strength, and dosage form
- Quantity prescribed
- Directions for use
- Name, address, and DEA number of prescriber
- Signature of prescriber
Correcting C-II prescriptions
Adding or correcting patient’s address
Adding or changing dosage form, strength, quantity, or directions for use
after confirming with prescriber
What can not be changed on C-II prescriptions?
Name of patient
Name of drug (except generic sub.)
Name of prescriber, including signature
A new prescription must be issued for any mistake that cannot be updated
Correcting C-III, C-IV, C-V Prescriptions
The only difference from correcting C-II prescriptions is: because we can
accept verbal orders for these prescriptions, we can convert erroneous
written prescriptions into telephone prescriptions.
Need to get authorization from the prescriber to do this.
State-specific electronic prescribing requirements may impact the
ability to perform this change
Who is entitled to fill prescriptions?
Pharmacist
This includes anyone person who is authorized to dispense controlled substances under their supervision
Prescribers cannot fill prescriptions, they may dispense controls but not pursuant to a prescription
Written prescription
wet signature required (signed by hand by prescriber)
Faxed prescription
wet signature required
Electronic prescription
electronic signature required (utilizes a two-factor authentication to verify identity in an electronic system)
Telephone prescription
transcribed by a pharmacist or intern when received at the pharmacy. Can be called in by prescriber or an agent.
