Tag Archives: prescription

Just give ’em a pill? I can’t even do that anymore.

Agents of the Drug Enforcement Administration have been pushing harder to investigate cases of nursing-home staff giving powerful medications to patients without a doctor’s prescription. But if that sounds all well and good, some say it’s just the nub of a more-complicated situation.

Trade groups for nursing homes and hospice-care facilities say “patients have been left to ‘languish in pain’ while nursing homes and pharmacies try to find ways to comply with DEA regulations requiring physicians, in most cases, to write prescriptions,” the WSJ reports this morning. The industry groups are pushing for a change in the law and the issue will be taken up at a Senate hearing today.

The DEA has been ramping up efforts to fight prescription-drug abuse, which some experts say may surpass the abuse of illegal drugs, the article says. In nursing-home cases, DEA has been acting out of concern for patients, according to a letter to lawmakers in December from an assistant attorney general in the Justice Department, of which the DEA is part.

But the industry groups say long-term facilities can’t afford doctors to write every prescription. “DEA’s reliance on hard copy prescriptions and failure to acknowledge the role of nursing in long-term care and hospice place additional burdens on prescribers, pharmacists and nurses and can substantially delay and in some cases, impede access to appropriate pain medication,” industry backers said in a brief quoted by the WSJ.

Wall Street Journal

Well, Mr.TheOne, I can’t even do that anymore for my patients.

This is one of the newest and biggest dilemmas we face at work. We have many residents and patients who suffer from chronic pain due to numerous different disorders and diseases.  We are now hindered from alleviating their pain and suffering because of these new DEA regulations. The DEA is lying when they say that they are “acting out of concern for patients.” If that were true, they would not be putting this monsterous barrier up between us (the caregivers and physicians) and the suffering patient.

There is no rampant prescription drug abuse in nursing homes. Again, another lie. There are numerous checks and regulations already in place to prevent this.

What they are talking about is nurse’s either stealing drugs from patients or prescribing drugs without a doctor’s order. Yes, nurses do steal drugs. But in all my years as a nurse (this  year marks my 30th anniversary) I have only known of 2 nurses who did this. They were caught and punished.

No one, I repeat, no one writes orders for narcotics without express permission from a doctor. Anyone who does this will be without a job and likely, without a nursing license. But gone are the days when a VO (verbal order) or TO (telephone order) is accepted. I could call a doctor, explain the patient’s situation and  write an order for something. Then I would fax the order to our house pharmacy. The doctor comes in once a week and signs all his TO’s.

But no more.

Now someone has to go to the doctor’s office, have the doctor write a hard script (just like you’d get in the doctor’s office) which has to be taken or faxed to the pharmacy to be filled.  In our case, which I’m sure is not much different from other long term care facilities, the medications only arrive once a day – after 7pm. And no deliveries on weekends. These patients can go over 24 hours (or more if it’s a weekend) in pain, without medication. The only thing I can give a patient is Tylenol and not even Extra Strength Tylenol. For that I need a doctor’s order.

We have a locked emergency narcotic box that has almost anything the a doct0r would order: Lortab, Vicodin, Dilaudid, Percocet, etc. But we can no longer use it. I don’t know why the pharmacy doesn’t take it home because we cannot use it. Even with a hard script, we cannot use it. That hard script has to go through a pharmacy. We can’t use it in-house.

I’m caring for a patient right now who has terminal esophageal and mouth cancer, with a trach.  He can’t talk and communicates with pen and paper. He has a gastrostomy tube that he is fed and gets all his medications through. He is on Roxanol (liquid Morphine) every 2 hours. Roxanol comes in 30cc bottles or 1 oz. He gets 1cc every 2 hours. Do the math: he will be out of Roxanol in about 2 days. I ran out on Friday night.

Now, I can blame someone (other nurses) for not realizing that he would be out of his Roxanol and then not getting it ordered. But the real problem is that I cannot get him anymore morphine and that’s the problem I deal with – it does him or I no good to blame others. All I want to do is give the guy his medication.

How do I control the pain these people are suffering when I no longer have the tools to do so, when the DEA has taken away my ability to do my job? These are bureaucrats who look at paper: reports and summaries and have no contact with the real world and real patients who are making rules that simply do not and will not work.

And on the flip side of this: if a patient does not get his medication, the state will site US for neglect and abuse. And on the flip side of the flip side, it’s getting harder and harder to get doctors to sign on at nursing homes due to the Obama Medicare cuts. Things will not get better, thanks to TheOne’s medical Utopia.