The True Proper Way To Write An Opiate Prescription

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So we had this discussion about what is the true/official proper way to write an opiate description or any of the restricted drugs for that matter.

Here are some things that were stated that I would like to verify:

1) The name + dose, rate, the disposition are all on separate lines.

2) You have to write the date September 16, 2007. You can't use 9/16/2007?

3) You have to write q 12 hours (cant use the superscripted circle).

4) You have to say tabs, you can't use the T with 1 dot on it by itself.

Comments? What's official?

 

[3dtp]

So we had this discussion about what is the true/official proper way to write an opiate description or any of the restricted drugs for that matter.

Here are some things that were stated that I would like to verify:

1) The name + dose, rate, the disposition are all on separate lines.

2) You have to write the date September 16, 2007. You can't use 9/16/2007?

3) You have to write q 12 hours (cant use the superscripted circle).

4) You have to say tabs, you can't use the T with 1 dot on it by itself.

Comments? What's official?

I don't know what's official, and I work with a relatively high risk population and write a fair amount of opiates for cancer pain management. My personal practice is to not use abreviations on scheduled substances and to write out everything.

Two reasons: 1 it makes it harder for the patient to alter things. For example, if I write for an opiate it is far harder to alter "take one or two tablets by mouth every four to six hours" than it is to alter Sig 1-2 tabs PO q4-6h. Likewise when I write the quantity, I write disp #63 (sixty-three) which is also much harder to alter.

Second reason: I got a call from a pharmacy once questioning a prescription. It had my DEA number on it. I had him fax it to me and lo and behold, it was written in script language making it very easy to spot the forgery and a well done forgery it was, too, just not my style or handwriting. The second time it happened, I asked the pharmacist how it was written and got the "wrong" answer. No need for fax, this time, it was a fraud.

 

[TRAMD]

. . . is to never write it.

 

[Winged Scapula]

Mofine 1 pound

(or so says the urban legend)

 

[Bertelman]

1) number of pills is script, eg twenty (20)
2) number of refills is script, or "no refills" is written, instead of using the checkboxes on many hospital Rx pads.

 

[Blade28]

Important differences between writing for Schedule meds vs. normal ones:

*Write out the amount, e.g. "Disp: 60 tabs (sixty)"
*DEA number
*Usually on a special prescription (pink or gold here)
*Usually no refills on the Schedule 2 meds (like Percocet)

 

[Tired]

Who exactly makes these "true, official" rules?

Five bucks says the answer is convention.

 

[lord_jeebus]

I'm on a pain clinic rotation and we break almost every "rule" mentioned above without issues. "Oxycontin 10 mg #60 T PO bid" seems to be working fine. We are using the special pads.

I have seen script used for 3 digit numbers. (eg. six hundred)

 

[sdn1977]

Who exactly makes these "true, official" rules?

Five bucks says the answer is convention.

You owe me five bucks!

But, I'll let you keep it - none of these are actually true "rules".

The rules are state dependent. So, what is legal in WA (which is very strict) & what is legal in CA (we are less strict than we were a few years back) & what is legal in PA are all different. Some state may require these, mine does not (I think WA doesn't allow using script writing - only printing, but not sure).

For CA - we need a particular kind of rx (tamper resistant & made by only certain manufacturers).

Your office staff now can write everything on it - except for your signature. There are no refills on CIIs (except for hospice pts who occupy a completely different place in the law).

As for everything else - all these other things suggested are good for preventing tampering. Personally, I like both numbers (either cardinal or Roman numerals) as well as written, but I'll take either. I don't care how you write the date. In my state, the DEA # has to be printed on the rx.

I also prefer you write 1-2 rather than i-ii only because the ink sometimes smudges or people drip things on the rx before it gets to me. Otherwise, I don't care about the sig - just write it so I can read it. Oh - take as directed is not legal in CA.

Fortunately, I know my prescribers. If I don't, I don't fill until I verify the rx. Most prescribers know to tell their pts to get the rx filled locally, even if they are out-of-town patients. If I have an rx with an error (no date, no quantity, etc..) & I know the rx is otherwise is valid.....I'll fill enough for 24 hours & verify the missing info by fax. Fortunately, this is a change in CA law which gives us lots & lots of flexibility - we don't have to be the "bad" guy.

btw.....I have one pt who uses 3700 Oxycodone 5mg per month. Yes - 3700! He's a terminal, cash CA pt & this is the least expensive way for him to manage his pain (makes me nauseous just to think about it, but there it is). So, the number of digits doesn't always make it questionable😉.

 

[deleted109597]

Maybe you all can tell the pharmacies of the world that the new DEA numbers don't begin with A or B. That way Eckerd's can stop ****ing calling me. I even showed them my card, and they tried to tell me that it was fake. Now I just tell my patients not to go there.

Also, I don't know of any state where you can get refills on Schedule II drugs. Schedule III and higher, sure, but not schedule II.
Some don't even allow them for III and IV, if I recall right.

 

[sdn1977]

Maybe you all can tell the pharmacies of the world that the new DEA numbers don't begin with A or B. That way Eckerd's can stop ****ing calling me. I even showed them my card, and they tried to tell me that it was fake. Now I just tell my patients not to go there.

Also, I don't know of any state where you can get refills on Schedule II drugs. Schedule III and higher, sure, but not schedule II.
Some don't even allow them for III and IV, if I recall right.

I'm sorry! I'm guilty of this😳!

The DEA didn't tell us they were using "F" numbers - that's what you were referring to right (😉)

No, really - I did make the mistake of having to call someone about the FXYZ# - but, my husband is an "old" guy - not THAT old, but old enough to have an "A" number. So.....those d*mn "F" numbers crept up on us. And - no I have NO idea what happened to C, D & E!!!! I made that poor prescriber (a dentist) really uncomfortable - not intentionally - but, she also wrote a Crx on a blank which was not her own. Two wrongs don't make a right, but at least I admitted mine. I asked her to call it in (only T3) until she had her own blanks printed (this is a dental "mill" - she's not likely to have a blank with her own name).

As for refills on CIIs - some states allow hospice pts to receive an rx for a narcotic - say MS oral liquid 20mg/ml & have it written in a large quantity - say 120 or 240ml. In CA, we can then dispense it in 14 day aliquots up to 5 times. But, they have to be hospice pts - again...they occupy a completely different place within CA law to allow for the titration up/down of the dose & to not have too much in the home (charged to the hospice) anymore than necessary. The dose is intentionally written to be variable & the nurse gives us direction of how much the pt is taking so we can provide enough in 14 day cycles.

So sorry about the confusion. Really - the DEA did not inform us, nor did my state board.

I apologize for my colleagues🙁....

In CA, we can have 5 refills for CIII-V up to 5 per 6 month period.

 

[Apollyon]

Maybe you all can tell the pharmacies of the world that the new DEA numbers don't begin with A or B. That way Eckerd's can stop ****ing calling me. I even showed them my card, and they tried to tell me that it was fake. Now I just tell my patients not to go there.

I have an "F" DEA number, and have gotten ZERO pharmacy calls about it. None.

 

[deleted109597]

I have an "F" DEA number, and have gotten ZERO pharmacy calls about it. None.

That's because all the pharmacies in your town are still scared from my wrath.
Not really, I haven't yelled at any of them. It is pretty frustrating though, especially with the fact that they won't give the patients their Lortabs or whatever I invariably am giving them.
I guess it really only bothers me if it keeps them from getting their Plavix.

 

[docB]

It's all just the outpatient counterpart to the JCAHO "no abbreviations" silliness. If no meds get delivered then no medication errors can occur.

 

[Blade28]

I have an "F" DEA number, and have gotten ZERO pharmacy calls about it. None.

I also have an "F" DEA number, but the hospitals here have an "A" institutional number.