Lecture 12 - Controlled Substance Prescribing Flashcards
Who can prescribe controlled substances?
-Practitioners authorized to prescribe
-Controlled substance prescribers must have a DEA number or be exempt from registration
-Agents can not communicate C2 emergency prescriptions, as the DEA notes a prescriber cannot give agency to anyone for this type of prescription
What does it mean when it says a prescription must be “issued for a legitimate medical purpose by a practitioner acting in the 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 (requires at least one in-person patient evaluation or telemedicine visit)
Who is responsible for the proper prescribing and dispensing of controlled substances?
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
How could a pharmacist be violating the law of corresponding responsibility of filling a prescription?
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 do not 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
How do you document issues on a prescription?
-Do not deface the prescription because it is the property of the patient
-Small notes are okay as appropriate
What should you do with a prescription if you choose not to fill it
-The prescription should be returned to the patient unless the prescriber asks you to destroy it
-Document rationale for filling or refusing to fill a prescription
What kind of signature is required for a written prescription?
Wet signature
What kind of signature is required for a faxed prescription?
Wet signature
What kind of signature is required for an electronic prescription?
Electronic signature (utilizes a two-factor authentication to verify identity in an electronic system)
What kind of signature is required for a telephone prescription?
Transcribed by a pharmacist or intern when received at the pharmacy. Can be called in by prescriber or agent
What types of prescriptions can a C2 prescription be dispensed?
-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
When can a faxed C2 prescription be treated as the original prescription?
-Narcotic C2 that is an injectable
-Narcotic C2 in hospice care
-All C2s in a long-term care facility
What types of prescriptions can a C3, C4, C5 be dispensed?
-A written, paper prescription signed by the prescriber
-An electronic prescription transmitted by the prescriber
-A fax prescription transmitted by the prescriber or the prescribers agent
-A telephone prescription promptly reduced to writing by the pharmacist
When can a controlled substance be administered without a prescription?
Only by an individual prescriber
What can institutions do?
May administer or dispense based on a prescription order from an individual practitioner if it is dispensed for immediate administration to the patient
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
What can you not update on a C2 prescription?
-Name of the patient
-Name of the drug (except for generic substitution)
-Name of the prescriber, including signature
Can you correct C3-C5?
-Yes 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 can fill a controlled substance prescription?
-A pharmacist
-Prescribers cannot fill prescriptions. They may dispense controls, but not pursuant to a prescription
