Legal and professional issues unique to prescribing in Florida
Prescription refers to an order that is usually written in a formal format by a licensed health professional and which assists in the administration and preparation of drugs. In each country, the laws governing prescription differ from state to state. The legal individuals responsible for making prescriptions are different in each country. In Florida, prescription laws are from the Board of Medicine and Pharmacy Practice, but they are not all-inclusive. Several professions that have authority to make prescription in Florida include physicians, physician’s assistants, and optometrists, podiatrists, advanced registered nurses, dentists, and osteopathic physicians. In the year 2016, nurse practitioners and physician assistants were also allowed to make prescription in Florida. Although registered nurses and Physicians assistants are now allowed to make a prescription, they are limited to making psychotropic medication for any child below 18 years as this is only legally done by a Psychiatric Nurse. Legal and professional issues that are unique to prescribing in Florida have been at the centre of analysis with the aim of understanding the policies that govern the authorized professions in matters relating to prescribing.
In Florida, HB 423 is a law that came to effect in the year 2016 which comprise of several components of the nursing profession. It included the licensure requirements for the nursing discipline, and a prescription is among the requirements. According to the law, physicians Assistants and Advanced Registered Nurse Practitioners are allowed to make prescription of controlled substances that are listed in Schedule I to IV. ARNP certified as Psychiatric Nurses are the only nurses allowed to make psychotropic medication to mental health children and not any other nurse (Kellams & Maye, 2017). PAs and ARNPs are not allowed by the law to make a prescription for a more than 7-day medication for controlled substances as that is the role of ARNP psychiatric nurse. A pharmacist has the role of confirming that a nurse making a psychotropic medication is a psychiatric nurse as they are the only nurses with the responsibility of dealing with psychiatric mental health controlled substance. In spite of the legalization of prescription, the nurses should be registered by DEA.
Due to probable professional issues, pharmacists and other health professionals authorized to make prescription should not, in any case, make a personal prescription for controlled substances. Only psychiatric nurses have the mandate to prescribe controlled substances. Also, if they have to prescribe drugs to family members and friends, the rules for making a prescription should apply in all cases. The rules call for a clear understanding of effective treatment methods for all diseases by psychiatric nurses so that they can make the right treatment to themselves as well as to the family members (Fass & Hardigan, 2011). Despite the authorization, practitioners should rely on history and physical outcomes of patients and not electronic medical questionnaires. The use of medical history ensures the right diagnosis is made for both the patients and family members.
In Florida, it is illegal to make a prescription through a phone call. Customers or rather patients especially those with mental conditions should go to the pharmacy where they originally picked the first medication, but they should not call for a delivery. Every prescription requires physical contact between the patient and the mental health nurse practitioner so that the pharmacist can make a relevant assessment before giving out the drugs (Fass & Hardigan, 2011). The only time a patient is required to make a phone call is during a refill, and that time, the pharmacy’s phone number should be used which is listed on the initial prescription. Hence, mental health nurse practitioner should not make a phone prescription to patients as that can lead to legal liability.
The increased use of electronic prescribing networks in Florida has led to legal issues. The systems used are prone to reformatting the prescriber’s transaction to make it more accepted by the pharmacy systems. In the process, the initial prescription gets tampered with, and this translates to wrong medication. Although this can be the case, advanced electronic prescribing networks can provide warnings, reminders, and alerts to dispensers or prescribers which can minimize the chances of wrong medication (Dutko, 2009). Healthcare facilities that use electronic prescribing systems have increased security issues because the prescription can be made by a wrong medical practitioner, but they quicken the process where they communicate directly to the pharmacist. Electronic prescribing networks use a combination of security features to ensure that patient information is protected from illegal access.
Due to the high potential for drug abuse in healthcare, mental health nurse practitioner should be authorized by DEA so that they can prescribe all controlled substances. All controlled substances are classified under different three schedules. The first schedule has increased the risk of abuse but is not legally accepted in Florida, the second schedule is prone to abuse but has minimal use in the country while the last schedule has minimal likelihood of abuse and are acceptable in medical line (Kellams & Maye, 2017). Such risks require prescribers to know the three schedules so that they can maintain minimal abuse of drugs. Due to such risks, state and federal government provide requirements for making a prescription where only authorized personnel should make the prescription. PAs and regular ARNPs are not allowed to prescribe controlled substances above seven days. This minimizes cases of illegal use or drug abuse as well as wrong prescriptions.
Pharmacists are the responsible medical professionals to assess whether the prescription is valid in Florida. All orders especially for controlled substances should meet certain criteria and should identify specific elements so that they can be considered valid by the pharmacist. Failure to meet the required standards of the prescription has been a common profession issue currently affecting Florida healthcare system. The standard prescription should identify the patient mental condition, the drug to be prescribed, the quantity of the medicine, date of the order, directions to use that drug as well as the practitioner involved in the prescription (Kellams & Maye, 2017). To minimize prescription liability, pharmacists should check the validity of the prescription so that any ethical and legal issue can be directed to the right medical professional.
In Florida, a prescription for controlled substances is not allowed unless one has an active DEA number and a registration from the country. Also, the laws require that a mental health nurse practitioner make the prescription and not any medical professional so that they can prescribe for a genuine medical purpose. The increased use of opioid drugs necessitated the enforcement of laws that could govern when to make a prescription and for what reason the prescription should be made (Kennedy-Hendricks, 2016). Thus, a mental health nurse practitioner should ensure all steps are followed during prescription as required by the Florida prescription laws.
Legal and policies perspectives
Backer Act is a law used in Florida which encourages voluntary and involuntary examination of patients. The law allows families and other related people to access emergence mental health services as well as temporary detention for individuals who depict mental illness especially those who are not aware of needs for treatment (Christy, 2007). The examination is done to help in the early detection of mental illness so that psychotropic medication can be prescribed on time. The law has assisted the mental health nurse practitioner in the identification of mental health patients so that the right prescription can be made. The law also ensures that only mental health nurse practitioner makes a prescription for controlled substances especially for patients below the age of 18 years.
In Florida, a new law has been established which limit the use of opioids which have also provided $65 million for fighting the drug abuse epidemic affecting the world. House Bill 21 is the new law which limits the use of acute pain prescriptions as a way to enhance drug control monitoring program. The policy has added to the treatment opportunities, outreach programs, recovery support services as well as giving resources that enhance laws for consumer protection (Patrick, 2016). Ultimately, the policy will minimize the chances of drug addiction by limiting the use of acute medication and promoting the only prescription for the right treatment. Outreach programs will also educate individuals on the importance of correct prescription which will reduce cases of drug addiction.
The legible prescription law requires that all prescriptions made either typed or written be legible. More to this, the quantity of the drug should be written numerically and in a text format. Also, the date of the prescription should be written as a text, and the prescription should be signed before dispatch. In spite of the rules made, the law does not prohibit the use of standard abbreviations like ‘t.i.d and p.o” by the practitioners (Peaden, 2005). In Florida, the law is only applicable to written prescriptions and not any other written orders. Thus, it should be written in such a way that a pharmacist filling the prescription should understand. What is more, that prescription should include the name of the practitioner responsible for making the prescription so that in case of a wrong prescription, the practitioner can be liable.
The rule 64B8-36.001-.003 in Florida Administration Code was created among many other statutes which highlighted the medicines and drugs that a pharmacist is allowed to dispense to consumers. The policy also includes conditions under which a drug should be ordered and dispensed. Another code used in Florida is under the rule of 64BI6-27.500, which include all medicinal drugs proved to have clinically or therapeutic implication and if they are substituted; the clinical effects expected are explained (Patrick, 2016). It also includes the threat that can be associated with certain medications. Thus, it has assisted authorized practitioners to ensure prescription of the right drug to consumers.
References
Delcher, C., Wagenaar, A. C., Goldberger, B. A., Cook, R. L., & Maldonado-Molina, M. M. (2015). Abrupt decline in oxycodone-caused mortality after implementation of Florida’s Prescription Drug Monitoring Program. Drug and alcohol dependence, 150, 63-68.
Dutko, A. (2009). Florida’s Fight Against Prescription Drug Abuse: Prescription Drug Monitoring Program. Nova L. Rev., 34, 739.
Fass, J. A., & Hardigan, P. C. (2011). Attitudes of Florida pharmacists toward implementing a state prescription drug monitoring program for controlled substances. Journal of Managed Care Pharmacy, 17(6), 430-438.
Kennedy-Hendricks, A., Richey, M., McGinty, E. E., Stuart, E. A., Barry, C. L., & Webster, D. W. (2016). Opioid overdose deaths and Florida’s crackdown on pill mills. American journal of public health, 106(2), 291-297.
Patrick, S. W., Fry, C. E., Jones, T. F., & Buntin, M. B. (2016). Implementation of prescription drug monitoring programs associated with reductions in opioid-related death rates. Health Affairs, 35(7), 1324-1332.
Christy, A., Stiles, P. G., & Shanmugam, S. (2007). The Florida mental health act (Baker Act) 2007 annual report.
Kellams, J. R., & Maye, J. P. (2017). The Last State to Grant Nurse Practitioners DEA Licensure: An Education Improvement Initiative on the Florida Prescription Drug Monitoring Program. Journal of addictions nursing, 28(3), 135-142.