e-Profile Login and ID Quick Search
Nurses as Agents of Prescribers in Long-Term Care Facilities/Alternate Care Sites (Resolution No. 102-6-06)
Resolution Number: 102-6-06
Title: Nurses as Agents of Prescribers in Long-Term Care Facilities/Alternate Care Sites
Action: Passed
Whereas, on April 25, 2001, United States Drug Enforcement Administration (DEA) issued a notice in the Federal Register soliciting comments regarding preventing accumulation of controlled substances at long-term care facilities (LTCF) (66 FR 20833). In that notice, DEA clarified their interpretation regarding physician’s agents, stating that no legal agency relationship exists between a LTCF nurse and a physician and, therefore, controlled substance orders written or verbalized by physicians then relayed by LTCF nurses to pharmacists are not in compliance with DEA requirements; and
Whereas, this issue of legal agency is also found in hospice and other alternate care sites; and
Whereas, the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act) currently does not address in detail the issue of agency relationships, but recognizes agents of all prescribers (as opposed to only physician prescribers) and allows agents to communicate prescription drug orders to pharmacies; and
Whereas, a recent proposed amendment to the Model Act states that, in institutional facilities, for an agency to be valid, agents must be “authorized by and in accordance with written policies and procedures of the facility and applicable state and federal laws” and would allow LTCF and alternate care site nurses to legally communicate non-controlled substance medication orders to pharmacies, provided the facility maintains written policies and procedures facilitating the prescriber-LTCF/alternate care site nurse agency relationship; and
Whereas, the DEA interpretation referenced above, as it presently exists, creates barriers to quality and timely patient care by requiring multiple contacts among prescribers, LTCF and alternate care site nurses, and pharmacists with regards to controlled substance medication orders; and
Whereas, patient care would be significantly improved if DEA modified the interpretation reference above;
THEREFORE BE IT RESOLVED that NABP ask DEA to reexamine its interpretation of the agency relationship between LTCF and alternate care site nurses and prescribers and consider recognizing the agency relationship in the presence of written facility policies and procedures that comply with applicable state and federal laws to allow for the LTCF and alternate care site nurses to legally communicate controlled substance orders and changes to such orders to pharmacists responsible for the care of the patient.
(Resolution passed at NABP’s 102nd Annual Meeting, San Francisco, CA)
