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North Carolina Nurse Practitioners Must Know These 6 Things If They Are Prescribing Medication

#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)

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