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Some patients will be crafty about seeking improper narcotics prescriptions, but preventive measures can make it much harder for them to succeed, according to Debra McBride, JD, assistant vice president for risk management at Midwest Medical Insurance Co. in Minneapolis.
McBride spoke on the topic at the recent meeting of the American Society for Healthcare Risk Management in San Diego, noting that patients often call after hours and use various ploys to convince the on-call physician a prescription is appropriate. Some patients alter legitimate prescriptions to obtain more than the prescribed number of pills.
She suggests clinics have a clear policy on how to handle such requests for narcotics refills. The policy is particularly important for after-hours requests. Over-prescribing of narcotics, she adds, is a liability risk, and these preventive steps can greatly reduce the chance of patient injury and malpractice claims for over-prescribing:
• Write initial prescriptions only after exam ining the patient.
• Process refill requests only during clinic hours and inform your patients of that policy.
• Refill controlled substances only with the approval of the original ordering physician.
• Handle off-hours requests for narcotics by prescribing a very limited quantity, possibly only enough to get the patient through the night. An alternative is to refer the patient to the emergency department for evaluation.
• Document all prescriptions and refills on the medication record to prevent over-prescribing.
• Urge your staff to avoid using digits for medication quantities. The word "ten" cannot be altered to "100" the way the figure "10" can. Use the word "none" for refills, not "0."
• Document when established patients make inappropriate refill requests by indicating that the refill was denied. If you see many such entries for a patient, consider patient counseling.
• Keep medications/prescription pads locked up. Report thefts of drugs or prescription pads.