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New DEA nurse prescribing policy still needs work, providers say

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Recent Drug Enforcement Agency guidance that allows nurses to to fill certain pain medication prescriptions is a good start, but it doesn't go far enough, provider groups say.

The DEA's recent policy change allows long-term care nurses to relay verbal orders from physicians to pharmacists after signing a written agreement. They must be deemed "agents of the prescriber." The policy requires that the provider, practitioner, pharmacy and all relevant parties maintain copies of the agreement. Schedule III, IV and V drugs are covered by the agreement.

One problem with the policy is it specifically excludes Schedule II narcotics, which are among the more common pain killers needed by nursing home patients at the end-of-life, or those who have recently received surgery, according to Evvie Munley, senior health policy analyst with the American Association of Homes and Services for the Aging. Also, the written agreements apply only to individuals, not nursing positions, such as the director of nursing or charge nurse. That causes logistical and tracking issues that could still result in unnecessary delays in patients receiving medication, according to Munley who wrote a post for AAHSA's “Future of Aging” blog. Regulatory and legislative experts at the American Health Care Association have expressed similar concerns about the policy change.

The DEA should allow the creation of a blanket position within a nursing home that can act as an agent of the prescriber, Munley argues. Legislation should also be passed to allow nurses to relay orders for Schedule II narcotics.

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