Practicum Journal: Safe Prescribing
Week 2 Practicum Journal: Safe Prescribing
There is probably no greater responsibility that the psychiatric mental health nurse practitioner assumes than the responsibility of prescribing medications. While someone can be harmed by psychotherapy, the level and intensity of the harm generally does not come to the same level of harm that can occur from improper prescribing. The PMHNP must understand his/her responsibility both at a state and federal level when it comes to prescribing medications.
In this Practicum Journal Assignment, you will explore the legalities associated with prescribing controlled substances, as well as what a DEA number is, how to obtain one, and, most importantly, how to prescribe controlled substances in your state.
Learning Objectives
Students will:
• Analyze roles of the Drug Enforcement Administration
• Analyze PMHNP responsibilities when issued a DEA number
• Analyze DEA number application procedures
• Analyze state requirements for safe prescribing and prescription monitoring
• Analyze PMHNP responsibilities for safe prescribing and prescription monitoring
• Analyze Schedule II-V drug levels
** Assigned in Week 2 and submitted in Week 4.
To prepare for this Practicum Journal:
• Review the Learning Resources.
In 2-3 pages:
• Describe the role of the Drug Enforcement Administration (DEA) as it pertains to the PMHNP.
• Explain your responsibilities when having a DEA number.
• Explain how you apply for a DEA number.
• Explain your state’s requirements for a safe prescribing and prescription monitoring program. Explain your responsibility as a PMHNP to follow these requirements.
• Provide an example of a drug you may prescribe from each of the Schedule II-V drug levels.
Every patient has a right to be prescribed the right medication upon visiting a healthcare facility. Getting the correct medication not only ensures that a patient’s chances of better outcomes are increased but it also minimizes the chances of medication errors and adverse effects (Gorgich, Barfrohan, Ghoreshi, et al., 2016). It is, therefore, important that a PMHNP is well versed with the state and federal legislation that guides the use and prescription of controlled drugs. This paper will discuss the role that DEA plays, responsibilities of a person in possession of a DEA number, application of DEA, requirements for the safe prescription of controlled drugs and the role of PMHNP, and lastly some examples of schedule II-Vdrugs will be discussed.
The Role of DEA
Kanouse & Compton (2015) point out that the main responsibility of the DEA is to ensure that the circulation of illegal narcotics is controlled. The Department of Justice oversees the activities of the DEA. The DoJ makes sure the federal laws that touch on the manufacturing, sale, use as well as the distribution of controlled drugs adherence. As regards the PMHNP, the role of the DEA is in ensuring that drugs are controlled and that the prescription and supply are done by licensed persons who possess a DEA number (Kanouse & Compton, 2015). This prevents the misuse and abuse of controlled drugs.
Responsibilities of Possessing a DEA Number
When a professional possess a DEA number it shows one’s competency in the controlled drugs prescription. A DEA provisional number ought to be given to a person that is licensed prior to attaining the number. Hence, a person is tasked by federal legislation adherence as pertaining to the drug prescription, manufacturing and distribution (Caulkins &Reuter, 2017)
Application of DEA Number
The acquisition of a DEA number is necessary for the legalization of controlled drugs prescribed to patients. One has to visit the DEA website to create an order form. Alternatively, a person can visit a DEA field where one gets a form that will fill to acquire the number. After filling out the form and submitting it, one should note the ID number with which a person can check the progress status. After a three day waiting period, a person can contact the DEA to find out if the registration is approved or is yet pending. Additionally, one can make any necessary changes, on the application form. A person needs to first hold a license for practice as well as a permit for controlled substance distribution prior to being issued with a DEA number.
Requirements for Safe Prescription, PMHNP Responsibility, and Cleveland’s Program on Prescription Monitoring
The process of manufacturing, distribution, and prescription of controlled substances in Cleveland is governed by several guidance rules. These guidelines aim at eradicating or at least minimizing incidences of drug abuse. A practitioner first has to register with the regional DEA office that heads the drug monitoring program. Once successfully registered, a physician is licensed to prescribe controlled drugs to a patient in need of the same in their treatment process. However, Bao, Pan, Taylor et al., (2016) point out that a physician is required to first consult with the PDMP of a patient before prescribing a controlled drug. Further, upon dispensing a controlled drug, a report should be filed on the same for accountability purposes.
As a PMHNP, I am expected to prescribed controlled drugs to patients residing in the area in which I practice my profession. I should not for any reason, self-prescribe. Regarding schedule narcotics, I should first check the ILPMP before initial first time prescription of the said drugs. This action ensures that controlled substances are not misused or abused and also medical errors are averted.
Schedule II-V Drug Examples
Controlled drugs are classified into schedules in order of their severity in the possibility of abuse and causing harm. They are also categorized based on their usefulness and possibility of dependence. The top of this list is the schedule II drugs. These drugs are likely to cause severe dependence both psychologically and physically with equally high abuse potential. Fentanyl is a schedule II drug that can be prescribed for patients with chronic pain and who have already developed a tolerance for other opioids (Ramos & Lope, 2019). Schedule III drugs have physical reliance that is low while psychological reliance is high. Pentobarbital is an example of a schedule III drug that can be prescribed for treating insomnia (Johnson & Sadiq, 2019). The schedule IV drugs have a lesser chance of abuse compared to the previous two schedules. Benzphetamine is one such drug in the schedule IV list. This drug is an appetite suppressant used in the treatment of obesity and overweight patients (Plodkowski, McGaeve, Reisinger et al., 2016). Schedule V drugs are moderately mild and Lomotil is one such example. Lomotil is used in the treatment of diarrhea (Khan, Asghar, Kanwal, et al, 2019).
Conclusion
Controlled drugs need to be administered by licensed professionals. Abuse and misuse of these drugs can cause a lifetime of dependence and in some cases, death. Physicians and NPs that are licensed to prescribe controlled drugs need to be vigilant and perform their due diligence before prescribing the drugs to a first-time patient. Additionally, a PHMNP should be knowledgeable on the correct dosage and prescription and always stay informed on any changes affecting the drugs the one prescribes.
References
Bao, Y., Pan, Y., Taylor, A., Radakrishnan, S., Luo, F., Pincus, H. A., & Schackman, B. R. (2016). Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Affairs, 35(6), 1045-1051.
Caulkins, J. P., & Reuter, P. (2017). Dealing more effectively and humanely with illegal drugs. Crime and justice, 46(1), 95-158.
Gorgich, E. A. C., Barfroshan, S., Ghoreishi, G., & Yaghoobi, M. (2016). Investigating the causes of medication errors and strategies to prevention of them from nurses and nursing student viewpoint. Global journal of health science, 8(8), 220.
Johnson, A. B., & Sadiq, N. M. (2019). Pentobarbital. In StatPearls [Internet]. StatPearls Publishing.
Kanouse, A. B., & Compton, P. (2015). The epidemic of prescription opioid abuse, the subsequent rising prevalence of heroin use, and the federal response. Journal of pain & palliative care pharmacotherapy, 29(2), 102-114.
Khan, H. R., Asghar, S. A., Kanwal, S., Qadar, L. T., & Qadri, K. H. (2019). Diphenoxylate-atropine (Lomotil) Toxicity in Infantile Diarrhea: A Case Report of Therapeutic Failure. Cureus, 11(10).
Plodkowski, R. A., McGarvey, M. E., Reisinger-Kindle, K., Kramer, B., Nelson, E., Lee, J., & Nguyen, Q. T. (2016). Obesity Management: Clinical Review and Update of the Pharmacologic Treatment Options. Federal Practitioner, 33(1), 6.
Ramos-Matos, C. F., & Lopez-Ojeda, W. (2019). Fentanyl. In StatPearls [Internet]. StatPearls Publishing.