SCPA Posted July 9, 2015 Share Posted July 9, 2015 Hi All, I work in state where NP's don't have schedule II prescribing privileges and PA's do. If the MD is out the NP's occasionally ask me to write their patient (who they have evaluated in the clinic and charted on) a schedule II. I maintain that if I didn't see the patient and chart on them , I can't write a controlled. Thoughts? SCPA Link to comment Share on other sites More sharing options...
FfIghter23 Posted July 10, 2015 Share Posted July 10, 2015 You are doing the right thing. I wouldn't in a million years write a Sch. II on a patient I've never seen. does the physician routinely write schedule II's on patients he hadn't seen? If so, that may be a bigger problem... He will have an awfully hard time defending that one in court. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 10, 2015 Share Posted July 10, 2015 What about writing refills for schedule II? Would you refill them for another provider you are covering in the clinic, even if you have never seen the patient? In my practice each provider is on call for other providers who are out. We share the time so I am on call for about 4 1/2 days per month. We get frequent requests for refills of sch. II from pts. and when their provider is out, it goes on the on-call's worklist. I have been refilling some and othersI am refusing to fill. It depends on the situation. I check the state prescribing/pharmacy site for adverse reports of those who might be misusing, refilling early, etc. It is really bothersome to me and my SP agrees with me. He refuses doing some refills too. But we get to the point where we get beaten down when we bring it up at our weekly meeting. I would prefer that only the initial prescriber of schedule II do the refills no matter what. We have been unsuccessful in getting anyone to agree to a policy on it and the organization doesn't seem to support it. I think it all has to do with being a PCMH and the providers just don't want to take the time to look up the patient, read their chart and be at risk of getting unfavorable patient satisfaction surveys or complaints that the patient might lodge against us. I'd appreciate some input on this too. Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 10, 2015 Share Posted July 10, 2015 I do not write controlled unless i physically see and examine the patient. if it is a refill on a patient that i have never seen, then i have the patient come in for a visit and i examine the patient and chart. remember, cotrolled drugs can land you in prison. no job is worth your freedom. there are also investigators that act like patients to monitor providers that they suspect of diversion. respect the controlled, refuse for patients that you do not personally treat. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 10, 2015 Moderator Share Posted July 10, 2015 This is a practice level issue that you can trump a little bit If you and the NP have the same SP/CP and this doc is aware of and is okay with the narcotics, then it would likely be abandonment to refuse to refill a routine script that was due on a patient seen who is under contract and not violated, and requested the refill in the correct time frame. This is a case where you are part of a care TEAM and the Doc is the one that has to be in the know...... (previous chart notes will support this) AFTER you saw the patient and entered a brief note in his chart and did any state data base checking that was required. Is this what you are referring to? If you are referring to a NP seeing a patient for an acute issue, and asking you to write an acute sch II script, it is a different story. I am a stickler on using narcotics (when appropriate) and not when not...... the claim of a sprained ankle with zero findings on exam gets motrin and RICE. The claim of a sprained ankle that is clearly swollen, tender, bruised, and not fractured (negative films - ottowa ankle rules) I do indeed give a small script of Sch II to if they request and I believe they will not miss use. In this case I would stick my head in the exam room, do a brief exam, write a one sentence note, and write the script. This issue is far bigger then you, the NP or the MD - the state itself has said that NPs do not have Sch II authority and I for one would never try to go around state laws. If your doc wants to then so be it, but as a PA I would follow the laws. If you doc insists that you write, then just insist on seeing the patients and making sure it is appropriate and database check is done. Keep a list and hand them off to your doc (intraoffice secure email is a great way as there is a record) No harm no foul. As to writing refills on patients of other providers when on call - HECK NO!!!!!!!!!!!!!!!! there MUST be a strict no refill policy for the entire practice. Data STRONGLY supports using contracts, testing, refill when office is open...... if they ran out of meds, or just forgot to call in, that is on the patient. I have not done a Sch II refill when on call for over 12 years. At first I was the only one in the practice doing this, and after about 2-3 months (I did one night a week, and one full weekend every two weeks) my call volume went way down. (In fact I refuse to do any routine refills on call for other providers) For non-scheduled meds I would offer them enough meds to get 2 business days in to the week - forcing them to call the office back to get it again...... for scheduled - "sorry I can't do that" was my answer. If they pushed I would advise them that if they were in extremis they should go to the ER (not trying to dump on ER's) After my call volume went down, the whole practice adopted the policy....... far easier. Now not a single PCP practice I am aware of in my county does ANY routine refills in the off hours. It is just bad medicine as the review and follow up is just not there........ If this is not what you are refereing to - well please expound on what you are referring to. Link to comment Share on other sites More sharing options...
LKPAC Posted July 10, 2015 Share Posted July 10, 2015 I work in state where NP's don't have schedule II prescribing privileges and PA's do. Sounds like a very smart state. Which is it? Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 10, 2015 Share Posted July 10, 2015 i think many practices work like this. all that i am aware of in fact. if an MD or PA is away for 2 weeks you cannot reasonably ask a patient with a pain contract/plan to come in for an extra visit. personally i advocate an office visit for all chronic opioid and benzodiazepine refills ... but thats me and my practice. if I am covering for someone I will often make a small refill of the medication until they return and can review the plan further. I would unlikely do this for a patient that did not have a chronic and well documented use of the medication. r Link to comment Share on other sites More sharing options...
jmj11 Posted July 10, 2015 Share Posted July 10, 2015 Hi All, I work in state where NP's don't have schedule II prescribing privileges and PA's do. If the MD is out the NP's occasionally ask me to write their patient (who they have evaluated in the clinic and charted on) a schedule II. I maintain that if I didn't see the patient and chart on them , I can't write a controlled. Thoughts? SCPA Absolutely! This should be a no-brainer for the NPs Link to comment Share on other sites More sharing options...
jmj11 Posted July 10, 2015 Share Posted July 10, 2015 I contacted a NP yesterday who had prescribed a chronic migraine patient (whom I had dismissed) #300 2MG hydromrophone + # 50 30 MG morphine sulfate tablets for 30 days. He did not return my call. This is plain nuts and malpractice. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted July 10, 2015 Administrator Share Posted July 10, 2015 I contacted a NP yesterday who had prescribed a chronic migraine patient (whom I had dismissed) #300 2MG hydromrophone + # 50 30 MG morphine sulfate tablets for 30 days. He did not return my call. This is plane nuts and malpractice. Contact the nursing board and copy the medical commission. You gave them an opportunity to explain... Link to comment Share on other sites More sharing options...
jmj11 Posted July 10, 2015 Share Posted July 10, 2015 Contact the nursing board and copy the medical commission. You gave them an opportunity to explain... My quote should have been "plain nuts" while "Plane nuts" are those little bags of bad tasting mirco pretzels you get flying on American. Link to comment Share on other sites More sharing options...
BruceBanner Posted July 10, 2015 Share Posted July 10, 2015 Absolutely not. I would NEVER Rx a controlled drug for a patient I haven't seen...especially schedule II's. My DEA license, my rules. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 11, 2015 Share Posted July 11, 2015 We had our meeting this morning and I brought up the issue o refilling other providers prescription for scheduled drugs. The answer was to only prescribe a small amount until the patients provide is back in the office. I realize I can just flat out refuse and have done that for patients who have a prescribing agreement on file that states only the pts. PCP is to do the refills. I have refused refilling anyone who is calling for early refill. Those whose PCP is on vacation will likely get enough to get them through to the day the PCP returns. My practice does not have a good policy on how we handle refills or even being consistent with having agreements on file. No one can agree on the terms and administration doesn't care. In two weeks a local DEA agent is coming to speak on the drug abuse problems in our community. Should be interesting. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 12, 2015 Moderator Share Posted July 12, 2015 STRONGLY push for ZERO routine refills on call Will be amazing how much your call volume goes down (everyone likes that!) It is just good medicine to be able to review refill requests in the EMR by the nursing staff prior to authorizing.... DEA should be STRONGLY for this policy Check you state laws on checking the database for other scripts - might be a law on the books that you can use to your advantage to sway them to do only business hour refills. You are still however still on the hook for the occasional true need for refills - ie htn, dm or other meds that the patient should not d/c. However only give enough to get into the next business week As this is an area that is fraught with problems, I would ask that the practice develop a specfic policy on scheduled drug refills on call - to make sure it is not violating state laws and placing you in a legal position to be avoided. Short of this follow state law.. Link to comment Share on other sites More sharing options...
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