Rx Pad: What Nurse Practitioners Must Include on Prescriptions

Prescribing practices are heavily regulated in most states, especially for nurse practitioners. There are very specific guidelines NPs must follow when writing prescriptions in general, and for controlled substances. Nurse practitioners who don't keep up with guidelines related to the information that must be included on prescriptions for these medications will find themselves bogged down with pharmacy callbacks, and and may even face discipline from regulatory bodies. So, it's essential to know what information must be included on prescriptions where you practice. 

Federal guidelines for writing prescriptions issued by the Drug Enforcement Agency (DEA) are the bare minimum that nurse practitioners are required to follow when writing prescriptions for controlled substances. The DEA's requirements for what must be included on a prescription when prescribing controlled substances are pretty basic. In general, the DEA requires the following information be included on prescriptions written for controlled substances:  

  1. Drug name, strength, dosage, quantity, directions for use, and number of refills (if any) authorized
  2. Prescription must be dated and signed on the date issued (may also enter the date written and 'Do not fill until...')
  3. The patient's full name and address
  4. The practitioner's full name, address, and DEA number
  5. Written in ink or typed
  6. Manually signature of the practitioner

These requirements are the same for prescribers across the board, physicians and nurse practitioners alike. 

State regulatory bodies typically take prescribing requirements further than the federal government, each publishing unique requirements for the information nurse practitioners must include on prescriptions. In Kentucky, for example, the state's Medicaid program issues very specific guidelines for tamper-resistant prescription paper. Prescriptions written for controlled substances for Medicaid patients in Kentucky must, for example, contain a watermark with the words "Kentucky Security Prescription" appearing horizontally, five times, in a twelve point Helvetica bold font. As you can see, guidelines get pretty specific regarding physical prescriptions themselves.  

Requirements for prescriptions written by nurse practitioners for controlled substances at the state level may include some, or all, of the following: 

  1. Name and/or DEA number of the supervising or collaborating physician
  2. State furnishing or prescribing number
  3. Check boxes to indicate medication quantity 
  4. Regulations prohibiting use of stamps with the drug name, or preprinted prescriptions
  5. Restrictions related to eprescribing and esignatures
  6. Limitations related to faxing of prescriptions
  7. Specific instructions for ordering and delivery of prescription pads (ex. in California, prescription pads may not be delivered to a PO box)
  8. Specifications outlining what constitutes tamper resistant prescription paper

While it can be difficult to keep up with guidelines for how your prescriptions should look, and the information they must contain, most prescription pad vendors help you stay on top of the process. When you order prescription pads, vendors typically cue nurse practitioners to enter information required in the appropriate practice state. If you prescribe through your practice's EMR system, it should be relatively easy to alter your prescription template to comply with state and federal guidelines

What information must be included on prescriptions written by nurse practitioners in your state?

 

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