Delta Health Education Partnership

Legal Requirements and Practical Tips in Writing Prescriptions

Objectives:

At the conclusion of this unit, the student will be able to:

1. Use the correct format for writing prescription medications.

2. Describe the proper procedure for writing controlled substance medications.

3. Understand methods for avoiding common errors in prescription writing.

4. Describe the legal and ethical constraints which affect the advanced nurse practitioner's ability to write prescriptions.

5. Locate resources for prescription medications for underserved clients.

Guidelines for Prescribing Legally

The most common medication errors are choosing the wrong drug and failing to monitor side effects. To avoid these errors follow the following guidelines:

1. Follow the 4 "rights": right medication, right time, right indication, right patient.

2. If your facility has a practice protocol or guideline, follow it. To obtain prescriptive privileges as an APN in Arkansas, you must have mutually agreed upon prescriptive guidelines with a collaborating physician. Keep them current.

3. If you must prescribe for something outside your guidelines, use a well recognized standard of care for prescribing. The Physician's Desk Reference is one such example. Although there are other and better publications, this is probably the most commonly used reference.

4. Before prescribing, always obtain the following information from a patient (where applicable):
a. pregnant?
b. breastfeeding?
c. allergies?
d. liver or kidney problems?
e. other current medications? (Include herbs and birth control specifically. Patients may not consider these medicines)
f. other medical problems?
g. have you taken this medication before, and response.

5. Address any cross sensitivities (i.e. allergy to penicillin may also mean allergy to cephalosporins, allergy to sulfa may also mean problems with some diuretics, antidiabetics and NSAIDs)

6. Address any contraindications. (i.e., a patient on coumadin may not need to take NSAIDs or ASA for pain management or someone with hepatitis should not take a drug with potential for liver damage.

7. Address any drug interactions. (i.e., theophylline and macrolide antibiotics)

8. Inform the patient of potential side effects and ask if the patient is willing to risk them.

9. Inform the patient to call or return if any adverse effects occur and point out which side effects require them to notify you.

10. Consider the cost of the medication. Can the patient afford it?

11. Consider whether the medication is covered in the formulary of the institution, HMO, managed care program. If not, is there an equivalent substitute which is, or can this one be justified to the program administrators?

12. Is there a potential for abuse of this medication?

13. Consider limiting the amount you prescribe, or the number of refills you authorize in order to encourage the patient to return for evaluation of response. (i.e., only give 3 months of new OCP prescription so that s/e, BP, etc can be monitored early.)

14. Develop your own formulary of commonly prescribed drugs. In most practices, you will tend to use the same drugs over and over. If you are prescribing a new drug, always look it up first and be sure to familiarize yourself with it before writing the prescription.

List adapted from Bupert, C. (1999). Nurse Practitioner's Business Practice and Legal Guide., p. 174. Gaithersburg, MD: Aspen.

Mechanics of Prescription Writing

1. All written prescriptions should contain:
a. patient's full name and address
b. prescriber's full name and address, phone number, and DEA number and credentials. (MUST sign APN, even if you also sign CNM or CRNA or CNS or NP)
c. collaborating physician's name, address, phone nubmer and DEA number.
d. date of issuance
e. signature of prescriber
f. drug name, dose, form, amount
g. instructions for use
f. refill instructions

2. Use only standard abbreviations. Examples of commonly used abbreviations in prescriptions:
a. sig: label
b. rx: take (prescribe)
c. po: by mouth
d. qs: quantity sufficient
e. hs: at bedtime
f. q: every
g. ac: before meals
h. pc: after meals
i. qid: four times daily
j. bid: twice daily
k. tid: three times daily
l. #: number
m. prn: as needed
n. c: with
o. s: without

3. When writing for controlled substances, you should remember the following rules:

a. Schedule II drugs:

In many states, including Arkansas, APNs may not write Schedule II drugs.

Must be a written prescription.

May be faxed if original prescription is presented prior to dispensing.

Preprinted prescriptions are not valid.

Valid 6 months from date of issuance.

b. Schedule III drugs:
Refillable up to 5 times in 6 months.

Valid 12 months from date of issuance.

May be faxed.

May be given as an verbal prescription.

Preprinted prescriptions are not valid.

c. Schedule IV drugs:
May be faxed or given as an verbal prescription.

Preprinted prescriptions are valid.

Unlimited refills.

Valid 12 months from date of issuance.

4. To avoid problems with your prescriptions:
a. Print

b. Include age and weight of pt if relevant.

c. Use metric system unless dealing with units.

d. Avoid uncommon abbreviations.

e. Sign your own prescriptions.

f. Keep your blank prescription pads in a secure place.

g. Inform your patient about their prescriptions.

h. Never leave a decimal point naked.

i. Make a habit of using the generic name, unless you require a specific brand. If the latter, indicate that no substitutions are allowed.

j. Call in your own prescriptions, or if you delegate, remember that you may NOT delegate to unlisenced personnel.

Resources:

Arkansas State Board of Nursing

Rules and regulations for advance practice, including prescriptive priviledges are in chapter 4 of the rules and regulations.

Needy Meds

A web site which lists various prescription assistance programs for clients who have no prescription coverage and cannot afford medications.

Quiz

Write prescriptions for the following situations.

Include all the necessary information.

Submit via email.

Case I: Molly Jenkins needs 50 mg of Zoloft every day. This is a new prescription. She has never taken it before.

Case II: Tom Henson needs to take 10 days worth of Ampicillin 500 mg 4 doses every day.

Case III: Sarah Jones may take one or two Tylenol #3 for headaches.

This page maintained by: Nancy Murray who can be reached at: nmurray@astate.edu 04/22/04 03:49 PM