#1: Include Prescribing/dispensing Authority In The Collaborative Practice Agreement
The collaborative practice agreement (CPA) must specify that the nurse practitioner is going to be prescribing and/or dispensing medication
If the nurse practitioner is going to be prescribing controlled substances, then it must be clear in the CPA which controlled substances the NP is authorized to prescribe.
Make sure the collaborative practice agreement states at which practice site, or sites, the nurse practitioner is going to be prescribing medication
#2: Exception To Requirement That Prescription Authority Must Be In The Collaborative Practice Agreement
A nurse practitioner may prescribe a drug or device not included in the collaborative practice agreement
BUT ONLY upon a specific written or verbal order obtained from a primary or back-up supervising physician
The specific or verbal order must be obtained before the prescription or order is issued by the nurse practitioner
Also, the written or verbal order shall be entered into the patient record with a notation that it is issued on the specific order of a primary or back-up supervising physician
That notation must be signed and dated by the nurse practitioner and the physician
#3: Be Aware Of Controlled Substance Prescription Rules
In addition to obtaining proper education and national certification, you will have to obtain a DEA number in order to prescribe controlled substances scheduled II through V
Supervising physician(s) must possess the same schedule(s) of controlled substances as the nurse practitioner’s DEA registration
Again, make sure what specific controlled substances you and your supervising physician(s) are authorized to prescribe is in your collaborative practice agreement
The nurse practitioner’s DEA number goes on all controlled substance prescriptions the nurse practitioner writes
#4: Be Careful To Whom You Prescribe Controlled Substances
21 NCAC 32M .0109 limits to whom nurse practitioners may prescribe controlled substances (as defined by State and Federal Controlled Substances Acts)
Do not prescribe controlled substances to the following people:
For your own use
To anyone in your immediate family (parent, spouse, sibling, child, etc.)
To your supervising physician(s)
To any other person living in the same residence as the nurse practitioner; or
To any person with whom the nurse practitioner is having a sexual relationship
If someone is pressuring you to prescribe them a controlled substance and it violates the above Administrative Code remember that it’s not worth your license
#5: Dispense Drugs And Devices Properly
If a nurse practitioner wants to dispense (not write prescriptions) drugs and devices, then the NP has to obtain approval from the NC Board of Pharmacy
It is not enough if your supervising physician is registered to dispense drugs
Nurse Practitioners can only dispense drugs/devices while under the supervision of a licensed consulting pharmacist from a facility holding a valid pharmacy permit.
Find a pharmacist with a valid pharmacy permit that you and your supervising physician(s) trust
Talk it over with your supervising physician as dispensing authority may not be worth your time
#6: Properly Write Each Prescription And Note It On The Patient’s Chart
Make sure that when writing a prescription that you note on the patient’s chart that the patient is being prescribed a certain medication and dosage, including amount prescribed, how to use it, and number of refills
Notation must be signed by the nurse practitioner that is prescribing the medication.
The following information is on every prescription written by a nurse practitioner:
Physician’s name
Patient’s name
Nurse Practitioner’s name, phone number and approval number
The NP’s assigned DEA number must be included as well (when a controlled substance is prescribed)
