Access to medications is one of the most important, if not the most important, concerns of a hospice nurse.This is especially true for patients admitted to inpatient care. Patients who are eligible for inpatient care are those most in need of medication at a moment’s notice and at all hours. Finding balance between meeting the needs and providing comfort for patients while being compliant with Federal and State regulations is critical–but often difficult.
In years past, hospice and long term care facilities have skirted Federal law and the DEA has looked the other way as all parties understood the barriers Controlled Substance laws could place on patient care at times. Recently however, the DEA is cracking down and enforcing the laws they once turned a blind eye to. This is due to the fact that technology, for the most part, has demolished those barriers. First came the fax machine and the DEA allowing faxed orders for CII medications to serve as the hard copy record. In 2010 electronic prescribing of controlled substances (EPCS) was approved, allowing practitioners to write and send CII orders from anywhere at any time and required no need for a pen or paper. With the accessibility of practitioners and the speed that orders are now transmitted electronically, facilities and pharmacies are being fined up to millions of dollars for improperly ordered “emergency” CII prescriptions, using standing orders or filling prescriptions with missing information. Costco recently settled with the DEA for $11.75 million for allegations of not handling controlled substances as outlined in the Federal Controlled Substance Act.
The Federal Controlled Substance Act is very specific when defining and outlining what is required on a controlled substance prescription. A prescription:
- Is an order for a medication which is dispensed to or for an ultimate user
- Is NOT dispensed for immediate administration to the ultimate user
- Must have DATE issued
- Must have full name and address of PATIENT
- Must have full name, address, and DEA number of PRACTITIONER
- Must have DRUG NAME, strength, dosage form, quantity, directions for use and refills if authorized
- Must be issued for a “legitimate medical purpose”
- If it\’s a written prescription it MUST be signed with pen or indelible pencil
- Electronic prescriptions cannot be printed and filled with e-signature
- Hospice CII prescriptions MUST have “Hospice/Terminally Ill Patient” written across the top of the prescription
- A prescription for controlled substances MAY NOT be issued to generally dispense to patients
If any one of these items are missing or inaccurate the pharmacist may VOID the prescription and refuse to fill it. The pharmacist is held as responsible as the practitioner to ensure these requirements are met.
Deadiversion.usdoj.gov. N. p., 2017. Web. 27 June 2017.