Risk Management

Tip

Virtually every physician, regardless of practice area, is involved in prescribing narcotics for pain control. Narcotic prescription is one of the primary areas of investigation and disciplinary actions by Medical Boards. In risk management, we look at two areas that require a heightened degree of care by the physician: the prescription process itself and clinical follow-up of narcotic prescription. Here are some tips to keep in mind when ordering an initial narcotic prescription or when approving a refill:

• Use legible handwriting when writing the prescription on a prescription form.

• If you are using an electronic prescription, make certain that only qualified personnel have access to the equipment.

• Keep prescription blanks and access numbers in a secured area, away from patients and unauthorized personnel.

• Have an office system in place to record all narcotic prescriptions and refills that includes number of tablets dispensed, person authorizing refill and pharmacy name.

• If you have a problem with a patient who requests frequent or inappropriate refills, consider prescribing to only one pharmacy in order to follow the prescribing pattern.

• If you suspect a patient is drug-seeking, require proper identification to ensure the patient is not using an alias in order to obtain narcotics.

Re-evaluation of narcotic therapy should be done when clinically indicated and on a periodic basis. Review the number of narcotics used and the adequacy of the patient’s pain control. Use the informed consent process to explain the reason for recommending on-going (or discontinuing) narcotic therapy, address alternative pain management techniques and advise the patient of the potential side effects of long-term narcotic use. If you suspect that a patient is drug-seeking, counsel them as soon as possible and attempt to determine alternative methods of treatment for pain control.

Our May Risk Management Tip will continue with this theme by setting forth guidelines to help physicians deal with patients who exhibit drug seeking behaviors. In the meantime, we hope these prescription tips will help you successfully manage patients who require narcotic pain control.

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