Safe Prescribing
Prescriptive Authority and DEA registration Process
The State Board of Nursing for registered nurses, is a state government organization established to protect the public through the regulation of the practice of registered nurses. The establishment and the State Board by law was by the Nursing Practice Act which deals with nursing licensure education, and practice. According to the licensing requirements and regulations in the State of Indiana, one should have an active, valid registered nurse license to be considered for prescriptive authority. The application process for the authority to prescribe controlled substances independently in Indiana for an advanced practice nurse (APN) does not require license as a practitioner (“PLA: Information & Application About Prescriptive Authority for Advanced Practice Nurses,” 2018). The prescriptive authority and DEA registration process require that all applicants mail their completed applications to the Indiana professional licensing agency. A valid and active register nurse license should be included for approval. Also, the process involves a $50 non-refundable application fee to be made to the state’s licensing agency. An advanced practice nurse seeking to dispense controlled substances must acquire an Indiana controlled substances registration approval. Also, the advanced nursing practitioner should also have a federal drug administration number. Prescribing of controlled substances in the State of Indiana requires that a practitioner have one controlled substances registration (CSR). Consequently, a practitioner should also make another separate registration for every practice address at which they physically possess controlled substances to give out. A practitioner holding one valid CSR is eligible to prescribe controlled substances throughout the State (“PLA: Information & Application About Prescriptive Authority for Advanced Practice Nurses,” 2018). A nurse practitioner must be licensed by the State of Indiana for them to be issued with a DEA number. Once the license has been validated and is activated, the nurse practitioner can apply for DEA number online. After successful submission of the application, it could take about one-two months to be issued a DEA number (“What Is a DEA Number and How Can a Nurse Practitioner Obtain One?”, 2018).
Safe Prescribing Practices
Physicians should not exclude or dismiss patients from their practices by their current use or requirement for opioids (Dowell, Haegerich, & Chou, 2016; Chou, 2016).
The decision to prescribe opioids should be founded on the understanding and engagement of the patient (Dineen, & DuBois, 2016). Therefore, the physician or advanced practitioner should conduct and document a comprehensive assessment of the patient. A thorough reassessment should also be done at least every three months.
During the initiation phase of treatment with an opioid medication, the practitioner should ensure that the patient is fully informed of the associated risks and benefits of the treatment (Cheatle, & Savage, 2012). Therefore, the patient and the practitioner should have a discussion that should be documented analyzing the rationale of the treatment, the expectations, and goals of both the patient and the health practitioner. A plan for the eventual possible discontinuation of the medication should also be developed.
Nurse practitioners should utilize appropriate and available strategies for the purposes of mitigating risk of harm when requested to prescribe a new prescription for opioid medication. Patients should be advised and informed on the dangers or risks of taking opioid medications while performing safety-sensitive occupations.
Healthcare providers have a duty in active control of the amount of opioid and sedative medication in society. Excessive prescribing of an opioid may expose the patient to the risk of more chronic use (Cheatle, Comer, Wunsch, Skoufalos, & Reddy, 2014).
References
Cheatle, M. D., & Savage, S. R. (2012). Informed consent in opioid therapy: A potential obligation and opportunity. Journal of pain and symptom management, 44(1), 105-116. doi: 10.1016/j.jpainsymman.2011.06.015
Cheatle, M., Comer, D., Wunsch, M., Skoufalos, A., & Reddy, Y. (2014). Treating pain in addicted patients: Recommendations from an expert panel. Population health management, 17(2), 79-89. doi: 10.1089/pop.2013.0041
Chou, R. (2018). CDC Guideline for Prescribing Opioids for Chronic Pain, 2016. Retrieved fromwww.cdc.gov/drugoverdose/prescribing/guideline
Dineen, K. K., & DuBois, J. M. (2016). Between a rock and a hard place: Can physicians prescribe opioids to treat pain adequately while avoiding legal sanction?. American journal of law & medicine, 42(1), 7-52. Retrieved from www.ncbi.nlm.nih.gov
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama, 315(15), 1624-1645. Retrieved from www.cdc.gov/mmwr/volumes/65/r
PLA: Information & Application Pertaining To Prescriptive Authority for Advanced Practice Nurses. (2018). Retrieved from https://www.in.gov/pla/2503.htm
What Is a DEA Number and How Can a Nurse Practitioner Obtain One?. (2018). Retrieved from https://www.registerednursing.org/answers/dea-number-how-nurse-practitioner-obtain-one/
