The Closed System of Controlled Substance Dispensing Flashcards
What does it mean to have a legitimate medical purpose and usual course of professional practice?
Acting in accordance with a standard of medical practice generally recognized and accepted in the United States
What is an example of the Scope of Practice?
Dentists are IPs, however they are not trained in the differential diagnosis of cough and therefore, should not be prescribing for this purpose
What is the meaning of Corresponding Responsibility?
- Pharmacists are legally responsible for the proper dispensing of controlled substances
- Knowingly standard is one of the conscious disregard for the obvious
- When suspicions exist, pharmacist is expected to exercise professional judgement and investigate
Pharmacists will more likely face enforcement action in situations that what?
Where there is blatant or glaring misconduct
What are the Prescriber Red Flags?
- Prescriber is outside pharmacy trade area
- Does not have relationship with patient (no medical evaluation)
- Routinely writes for large quantities of CDS
- Writes the same CDS prescriptions repeatedly
- Always provides the same diagnosis
- Writes outside scope of practice
What are the Patient Red Flags?
- Patient insists on paying cash
- Doctor or pharmacy shopping
- Resides outside the pharmacy trade area
- Asks for controlled substance by the color or manufacturer or street names
- Routinely attempts to get early refills
- Groups arriving together form the same prescriber with the same medications
- Arriving at peak or closing times and asking you to rush
What are the Prescription Red Flags?
- Prescriptions written in dangerous combinations
- Multiple long-acting or short-acting opioids prescribed together
- Written for usually high dose or quantity
An example of prescription red flag of a dangerous combination is what?
Cocktails: opioid, benzo, muscle relaxant
Red Flags are what?
Circumstances surrounding the presentation of a Controlled Substance about the validity of a prescription
What can be an example of Documenting Resolution of Red Flags?
Asking the patient something, something to fall back on
What are ways to Resolve a Red Flag?
- Look at security features of prescription
- Verify DEA number
- Review PMP
- Ask the patient questions
- Contact prescriber
What are Security Features of a controlled substance prescription (written Rx)
- Watermarks: prevent photocopying
- Stamps or Embossing
- Quantity check-off boxes
- Signature line is microtext
- Void is more than one prescription is written per blank
What are the features of a DEA Number?
- Consist of 9 digits
- Typically 2 letters then 7 computer generated numbers
What does the 1st letter indicate in the DEA Number?
A, B, G, and F = dispensers
M = mid-level practitoner
P, R= distributors
What does the 2nd letter indicate in the DEA Number?
First letter of registrant’s last name or first letter of the business name
What are the steps for Verifying a DEA Number?
- 1st + 3rd + 5th
- (2nd + 4th + 6th) x 2
- Sum 1st and 2nd steps
- Last digit from step 3 = last number of DEA number
What are Prescription Monitoring Programs?
State PMPs require pharmacies to electronically transmit to the state a record of CDC prescriptions dispensed
PMPs can catch what?
Excessive quantities that are being follies outside of your pharmacy, assess patient risk, and see where they are filling too soon
PMPs can track what?
Patients, Physicians, and Pharmacies
What are practical considerations with PMPs?
- You must enter at least the first 3 letters of first and last name
- Look at more than just the last fill
- Be sure to look at fill date and NOT written date
- Patients could be under multiple names
What is Refusing to Fill?
- You know that the prescription is invalid
- You believe it is unsafe or could harm the patient
What is Waiting to Fill?
- Resolution of red flags can take time
- Refilling controlled substances excessively early may put patient at risk of harm and pharmacist at risk of litigation
What are the Considerations of Pain & Addiction Treatment?
- Pain vs. Addiction
- Legitimacy
- Clinical Judgment
- Federal/State Efforts Opioid Epidemic
Differentiating treatment of Pain from Addiction is important for what reason?
Determine whether the purpose of opioid treatment is legally for pain or illegally for addiction