Prescribing is an essential issue in nursing that requires the attention of care providers and regulatory bodies. In order to provide the best service to patients, nurses have to be aware of their state’s regulations regarding prescribing authority and have the necessary licenses to prescribe medications. The present post will explore the issues of prescriptive authority and DEA authorization in the state of New Jersey and apply this knowledge to the case study of Lori, an FNP-BC who works in a primary care clinic with a physician.
Prescriptive Authority in New Jersey
In New Jersey, nurse practitioners have prescriptive authority privileges when collaborating with a physician (Scope of Practice Policy, 2019). This means that, as a nurse practitioner working with a physician, Lori will be able to prescribe most drugs to patients without the need for a special authorization. This applies to medications that fall into schedules II to V and excludes dangerous or controlled substances.
However, if Lori needs to prescribe dangerous or controlled substances, she would need to complete a Controlled Dangerous Substance Registration, which includes a fee of $20 (New Jersey Office of the Attorney General, n.d.). This registration gives nurse practitioners and other advanced practice nurses permission to prescribe controlled substances, but would not allow them to purchase or maintain stock supplies of such drugs (New Jersey Office of the Attorney General, n.d.). Additionally, Lori would need to consult the physician before prescribing any controlled substance and obtain training in pharmacology on the subject of controlled substances (Scope of Practice Policy, 2019). These practices help to control the prescription of potentially dangerous drugs, thus preventing risks for the patients.
The U.S. Drug Enforcement Administration also requires care providers to register before they can issue prescriptions for controlled substances. This process usually follows obtaining a state license, because it is necessary to complete the application for a DEA number. Therefore, once Lori receives her state registration for prescribing controlled substances, she will need to fill out an application form 224 on the Drug Enforcement Administration’s website (DEA, n.d.). This application requires a one-time fee of $731 and is valid for three years (DEA, n.d.). After the number expires, Lori will be able to renew her registration by filling out form 224a. These practices are helpful in supporting safe prescribing because they ensure that each care providers’ license is current and thus they are not engaging in any illegal activity, such as drug diversion.
Besides obtaining the documents discussed above, Lori should also use safe prescribing practices to reduce the risks to patient health associated with medications. First of all, it is critical for her to prescribe medications based on the current clinical guidelines and ensure that patients have no contraindications to the chosen drug (Alford, Carney, Brett, Parish, & Jackson, 2016; Avery et al., 2014). Secondly, Lori should collect the information about each patient’s existing medications and check for adverse drug interactions with the chosen medication (Cahir, Bennett, Teljeur, & Fahey, 2014). Thirdly, she should provide patients with sufficient information about each drug to reach a shared decision and ensure compliance with the treatment plan. Finally, Lori should monitor and review patients’ prescriptions regularly to avoid polypharmacy where possible (Pasina et al., 2014). These practices will help to prevent patients from the adverse effects of drugs and drug interactions while ensuring that they get the most benefits from treatment.
All in all, the chosen case allowed reviewing the regulations related to prescriptive authority in New Jersey. Based on the information collected, Lori would need to obtain both the state registration and a DEA number to prescribe controlled substances. She would also need to consult the physician and complete relevant training. Other practices that improve prescribing safety include checking for contraindications and drug interactions, providing patient education, and monitoring the list of medications regularly.
Alford, D. P., Carney, B. L., Brett, B., Parish, S. J., & Jackson, A. H. (2016). Improving residents’ safe opioid prescribing for chronic pain using an objective structured clinical examination. Journal of Graduate Medical Education, 8(3), 390-397.
Avery, A. J., Rodgers, S., Franklin, B. D., Elliott, R. A., Howard, R., Slight, S. P.,… Sheikh, A. (2014). Research into practice: Safe prescribing. British Journal of General Practice, 64(622), 259-261.
Cahir, C., Bennett, K., Teljeur, C., & Fahey, T. (2014). Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients. British Journal of Clinical Pharmacology, 77(1), 201-210.
Drug Enforcement Administration. (n.d.). Registration categories and fees. Web.
New Jersey Office of the Attorney General. (n.d.). Controlled dangerous substance registration. Web.
Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M.,… Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs & Aging, 31(4), 283-289.
Scope of Practice Policy. (2019). New Jersey scope of practice policy: State profile. Web.