RESPONSE DISCUSSION

Suggest additional actions to take to ensure delivery of safe care.

Provide key components of a Malpractice Policy.

Validate an idea with your own clinical experiences with the support of an additional literature search

Casestudy: main post discussion

“Lori, FNP-BC, is a new graduate and has recently passed her certification exam. She has just been hired to work for a Primary Care Clinic in a small town. She will be working with one physician at one site.”

Substance Prescriptive Authority

Prescriptive authority for controlled substances varies by state and is dependent upon each individual state’s board of nursing. In the case study above, a new graduate nurse practitioner is going to be working in a small clinic with one physician. In Mississippi, advanced practice registered nurses (APRNs) are required to have a collaborating physician to practice and to prescribe controlled substances (Buppert, 2018). Lori will be working with a physician, and in Mississippi she would be considered to have a collaborative relationship with that physician. The Mississippi board of nursing (MSBON) has a strict process for nurses obtaining prescriptive authority for controlled substances. Licensed APRNs in Mississippi must first complete an online application for controlled substance prescriptive authority, answer an attestation question, and pay a one-hundred-dollar fee to the MSBON (Mississippi Board of Nursing, 2018). The APRN will then receive a Uniform Controlled Substances Registration certificate from the DEA, and the certificate must be provided to the MSBON for validation (Mississippi Board of Nursing, 2018). Finally, in the online portal a green bar will appear in the APRNs profile, indicating that the APRN is verified and qualified to prescribe controlled substances (Mississippi Board of Nursing, 2018). ARPNs in Mississippi have authority to prescribe sections II through V controlled substances once they obtain their DEA licensure (Mississippi Board of Nursing, 2018).

Safe Prescribing Practices

The prescriptive drug monitoring program (PDMP) is a national database that monitors controlled substances that are prescribed to patients in order to prevent overprescribing controlled substances, and to prevent dangerous drug combinations from occurring (Oregon State Board of Nursing, 2018). The Mississippi Prescription Monitoring Program (MSPMP) is the electronic monitoring system used by providers and pharmacists in Mississippi to monitor controlled substance prescribing (Mississippi Prescription Monitoring Program, 2020). The DEA diversion control division discusses the requirements for controlled substances. The DEA requires that all controlled substance prescriptions include the date, patient’s name and address, provider’s name, address, and DEA number (U.S. Department of Justice, 2020). The information that is required for the medication is the drug name, strength, dosage form, quantity prescribed, directions for use, number of refills, and manual signature (U.S. Department of Justice, 2020). Additionally, NPs in Mississippi must complete regular continuing education hours that specifically focus on controlled substance prescribing in order to renew their licensure (Buppert, 2018). In order to ensure that NPs are prescribing controlled substances safely, many requirements must be following the rights of medication prescribing, adhering to facility protocols or guidelines, or adhering to national guidelines if facility specific protocols are not in place (Buppert, 2018). The provider should also perform a full history and physical in order to safely prescribe controlled substances, including but not limited to pregnancy status, breastfeeding status, allergies, medical problems, current medications, and kidney and liver function (Buppert, 2018). To protect the provider, many organizations require urine drug screen monitoring, written drug contracts, and use of the prescription drug monitoring database to decrease the risk of drug abuse (Buppert, 2018). Prescribers may also utilize the Opioid Risk Tool prior to prescribing controlled substances to assess the patient’s potential for drug abuse (Buppert, 2018).

References

Buppert, C. (2018). Nurse practitioner’s business and practice legal guide (6th ed.). Burlington, MA: Jones and Bartlett Learning

Mississippi Board of Nursing. (2018). Advanced practice registered nurse. Retrieved April 7, 2020 from https://www.msbn.ms.gov/licensure/advanced-practice-registered-nurse

Mississippi Prescription Monitoring Program. (2020). About pmp. Retrieved April 7, 2020 from https://pmp.mbp.ms.gov/about-pmp/

Oregon Board of Nursing. (2018). PDMP registration to be mandatory for advanced practice nurses with prescriptive authority. OREG STATE BOARD NURSE SENTINEL, 37(2), 20. Retrieved from Walden University Library Databases

U.S. Department of Justice. (2020). Drug enforcement administration diversion control division: Prescriptions. Retrieved April 7, 2020 from https://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-2