#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
- You can request a DEA number by going to deadiversion.usdoj.gov
- 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)