Jurisprudence Primer 2

Prescription

outpatient/ambulatory settings given to the end user (patient)

Orders

inpatient/institutional setting provided to HCP to administer to end user

Legend drug

prescription drug

Prescribing authority

• given to practitioner by state in which they practice

• combination of legislation and regulation

• laws/acts and policies/procedures by varying states

• practitioner is never permitted to authorize someone else to prescribe

Scope of practice

• specific professional activities that each state authorizes clinical staff to perform based on training and clinical experience

• varies by state and related to prescribing authority

Mid-level practitioners

• practitioners other than physicians, dentists, vets, or podiatrists licensed/registered to dispense controlled substances in the course of professional practice

  • independent but with limited formulary: optometrists

• registration begins with M

• Physician assistants, APRNs, graduate assistant physician

Fields with no prescriptive authority

• physical therapists

• chiropractors

• pharmacists (controversial)

• psychologists

• registered nurse

• licensed practical nurse

PA Prescriptive authority

• must be under collaborative agreement

• cannot prescribe anything supervising physician is not authorized to prescribe

• supervising physician must be licensed in FL

• may NOT prescribe:

  • general, spinal, or epidural anesthetics

  • radiographic contrast material

• C-2 restrictions:

  • 14 day supply psych meds for children under 18

  • 7 day supply for all other C2s

  • may NOT prescribe C2s in pain management clinic

APRN prescriptive authority

• certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, psychiatric nurses, and certified nurse midvives

• some APRNs in primary care may be registered as autonomous (do not need supervising physicians)

• C2 restrictions:

  • limited to 7 day supply

    • UNLESS C2 is psych med prescribed by psych nurse

  • may NOT prescribe in pain management clinic

  • may NOT prescribe controlled psych meds for children under 18 (except psych nurse)

Psychiatric Nurses

• APRN with masters/doctorate in psychiatric nuses

• holds national advanced practice certification as psych mental health APRN

• has 2 years of post-master’s clinical experience under physician supervision

• NOT subject to 7 day C2 limit for psych meds

Graduate Assistant Physician

• medical school graduate practicing under direct supervision of a physician pending the graduate’s entrance into residency

• may practice under protocol with supervising physician and prescribe if protocol permits

• physician can supervise max 2 GAPs

• any rx issued by GAP must include name of GAP and supervising physician

• may NOT prescribe controls

• do NOT have DEA numbers

Certified Optometrist Prescriptive authority

• may administer and prescribe ocular pharmaceutical agents from approved formulary

• can prescribe certain oral drugs after additional training

Out of state prescriptive authority

• is rx is written in accordance with the state laws from the state where it was written, it can be filled in FL

• does NOT have to match FL laws (unless strictly prohibited in FL)

MD/DO prescriptive authority

• may legally prescribe a drug to treat any disease/illness

• DIFFERENT FROM dentists, podiatrists, and vets can only prescribe within scope

Advanced Pharmacy Practice Authorizations

• early attempt to provide limited pharmacist prescriptive authority

• passed in 1980s

• not used in practice but still active

Florida Pharmacy Act (Pharmacist’s Order for Medicinal Drugs)

• provides for committee to develop a formulary of medicinal drugs that a pharmacist may order (prescribe) and dispense as well as a dispensing procedure

• Eligible drugs:

  • drug in any strength whose active ingredient have been approved for OTC sale

  • any medicinal drug recommended by an FDA advisory panel for transfer to OTC status pending FDA approval

  • any drug containing antihistamine/decongestant as a single active ingredient or in combination

  • any drug containing fluoride

  • any drug containing lindane

  • any OTC drug approved for reimbursement by FL Medicaid

  • any topical anti-infectives

    • NOT eye/ear

• drugs on formulary may be dispensed only by the pharmacist ordering the drug and shall not be refilled, nor shall another drug be ordered for the same condition unless consistent with the dispensing procedures

• Drugs must be labeled with:

  • pharmacist name

  • name/address of pharmacy

  • date of dispensing

  • rx number

  • patient name

  • directions

  • clear statement that order cannot be refilled

  • trade name or generic name

  • quantity dispensed

• General Terms/Conditions:

  • cannot order injectables

  • cannot order for pregnant/nursing mothers

  • cannot exceed 34 day supply or standard course of treatment

  • patient shall be a advised to seek provider if symptoms do not improve

  • directions for use shall not exceed manufacturer recommended dosage

  • only in FL permitted pharmacy

  • must maintain patient profile separate from rx order and date/initial all profile entries:

    • maintain for 4 years

    • include PMH, CC, drug ordered