ANY scheduled medications, this can be a headache of migraine proportions. At my agency, we have handled it in the following manner: We are connected by laptop email and phone. When we get a call or see a patient who needs a controlled medication (we can't even prescribe schedule 5's) we write the script on our laptop in a form we use. We then email the form to one of the MDs we work with. If it's needed right away, we call the MD in question to let them know the email is on the way (we might text instead of call, depending on the urgency and time of day). The MD then knows to look in their email, open the form, sign it and send it on to the pharmacy. They do NOT see the patient in question that would be impossible. We have an average daily census of about 1200 patients, with a medical staff of 12. We are all out and about seeing patients, managing teams and accompanying IDG's, the MDs have all the death certificates to attend to, as well as fielding calls about admission criteria from the admission nurses. Our system has worked well for us for several years, but it's still a pain. We work tirelessly to get the laws changed. The evidence is clear that in states where NPs have full prescribing authority there are no issues with safety or increased drug addiction. It looks like Alabama will get a law passed in the near future, and Florida will stick out like a sore thumb on the US map of shame for maintaining its outdated policy. Beverly Douglas ARNP ACHPN® LifePath Hospice Tampa Florida [Submitted on: 8/27/2010 by: Beverly Douglas ARNP ACHPN® [bevdouglas@tampabay.rr.com]]
129. Prescription Regulations for Opiates. Beverly (and all)- My question would then be how are hospice drs allowed to write scripts for patients that they have not seen before. In reviewing all the regs that I can find, there is no "out" for a dr to write for a pt that they have not seen and that is what my attendings keep stressing to me. I know that it is done every day by hospices but how do they keep that legal? Surely some hospice docs out there have thought of these issues. If there is a way, I want to know so that I can also put it in place with my team so I can get these scripts out to these palliative patients of mine. Is this just a practice that goes on because it "always has" and no one has looked at it OR is there some sort of rule that I don't know about that is covering them legally? Does anyone know? Shreda Pairé, MS, RN, FNP-C, ACHPN® Advanced Certified Hospice & Palliative Care Nurse Practitioner Division of Geriatrics and Palliative Medicine The University of Texas Medical School at Houston Lyndon B. Johnson General Hospital 5656 Kelley St. Houston TX 77026 Phone: 713 566 4795 Fax: 713 566 2107 Email Shreda.Paire@uth.tmc.edu [Submitted on: 8/28/2010 by: Shreda Pairé, MS, RN, FNP-C, ACHPN® [shredanp@yahoo.com]]
129. Prescription Regulations for Opiates. For hospice care, the ATTENDING physician is