Lecture 2- Prescription writing and drug selection

independent prescriptive authority

provider is nOT subject to supervision or collaboration with an MD or DO in order to prescribe

without limitations

provider is not restricted from prescribing certain drugs, including controlled drugs, with the exception of schedule 1 drugs

NC prescriptive authority: controlled substances

• acute pain: prohibits prescribing more than FIVE day supply pf any controlled substance for acute pain

• post op acute pain relief: prohibits prescribing more than a SEVEN day supply of any controlled substance of POST OP acute pain relief immediately followign surgery

• refills/follow up: subsequent consultaion may result in renewal or new rx

NC prescriptive authority PA; handwritten

• pre printed rx pad with name, address, telephone of PA

• PA must sign

prescriptions must have

• prescriber name, license number, contact

• DEA/NPI/ Lic number

• pt name and DOB

• date rx written

• pt allergies

• name of med

• indication of med

• med strength

• dose of med and frequency

• number to dispense

• number of refills

phone in a script

any rx EXCEPT c-II (only in emergency)

• provider name, office allign from, and phone number

• pt name and DOB

• name and strength of med

• directions to pt

• quantitiy prescribed

• refills

• DEA number

reducing medication errors

• right pt

• right drug

• right dose

• right route of admin

• right time

transitions of care

• 50% of medication errors

• seeing for discharge appt and not updated from hospital

• ensure updates in discharge summary

rational drug selection

• cost

• guidelines

• availability

• interactions

• side effects

• allergies

• hepatic and renal function

• need for monitoring

• special populations

managing medication therapy

• is each med accomplishing its intended purpose

• is each still necessary

  • has condition changed

  • do adverse risks outweigh benefit

  • what would happen if some no longer prescribed

• what problems does each medication create

  • is a problem amplified by other drugs

  • are there drugs with fewer adverse effects

• if polypharmacy is an issue are there ways to decrease the number of meds

  • will combo drug simplify management