Oregon — Edition 10
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"My Prescription Has Run Out…" Refills And Oregon Law
Tracy Klein

Nurses and their employers frequently contact the Board about the practice of refilling medications by phone or electronic authorization. The high volume of calls is probably due to several changes in law and practice over the last decade, including the use of automated refill processes by pharmacies and increased use of electronic prescribing. The following advice addresses several frequently asked questions in an effort to provide a resource for all interested parties.

1. Who may authorize a “refill” in Oregon?

Prescriptions, prescription refills, and drug orders must be correctly dispensed in accordance with the prescribing practitioner’s authorization according to 855-041-0065 in Oregon pharmacy law.

2. How long is a prescription valid in Oregon?

A prescription for a non-controlled drug can be written for up to two years in Oregon by a prescriber. This is designated by writing the prescription with refills “prn up to ”. The use of this designation may help diminish frequent refill requests for routine medications.

A prescription for a controlled substance in Schedule III-IV may be refilled up to five times within the six months after the date on which the prescription was issued. A schedule II drug may not be refilled, but may be written following DEA guidelines for up to a 90-day supply. See http://www.Deadiversion.usdoj.gov/pubs/manuals/ pract/section5.htm for further details.

3. What if the prescriber is not available?

If the practitioner is not available and in the professional judgment of the pharmacist an emergency need for the refill of a prescription drug has been demonstrated (provided it is not a Schedule II substance), the pharmacist may dispense a sufficient quantity (not To exceed a 72-hour supply) of the drug consistent with the dosage regimen, until a practitioner can be contacted for authorization. The practitioner shall be promptly notified of the emergency refill (OAR 855-041-0065 (4)). Pharmacists may also develop collaborative therapy protocols with prescribers to minimize repeated requests for refills according to OAR 855-019-0260. Please contact the Board of Pharmacy for further details regarding these regulations.

4. What about refill protocols? My employer uses a protocol and standing order that allows the RN or medical assistant to order a refill.Is that consistent with the Board’s requirements?

Pharmacy law requires that refills of medications occur with the authorization of the prescribing practitioner. A protocol and standing order may be Used to authorize administration of medication or provision of a prescription to an individual patient (“patient specific protocols”) or for an individual condition (“condition specific protocols”).However, a protocol and standing order does not permit the delegation of prescribing functions such as routine refills by a nurse prescriber to someone without prescriptive authority, nor are Nurses authorized to renew/refill or extend a prescription that has expired without first consulting the prescriber.

5. What is an example of a patient specific protocol?

Chloe Jones is a 19-year-old, fulltime college student with asthma. Her physician has written a standing order for her to have nebulizer treatments x 2 if her wheezing meets specific parameters. She has additional regular prescriptions that she takes for asthma management. Nurses may implement the nebulizer treatments per standing order and protocol without an additional prescription or order.

6. What is an example of a condition specific protocol?

Multiple employees of a hospital are Exposed to meningitis by a patient. The occupational health office implements a protocol signed by their medical director that provides for administration of antibiotic prophalaxis to all patients who meet specific criteria for exposure and have no contraindications.Condition specific protocols are also used for immunizations for disease prevention/wellness indications.

7. What are common protocol/standing order errors?

Protocols which start with a diagnosis “Strep Throat” rather than a symptom “Pharyngitis” may lead to improper treatment or over-use of antibiotics.Protocols which do provide options for patients who are allergic, pregnant, and intolerant or contraindicated for treatments may contribute to medication Or treatment errors. Standing orders that are vague such as “refill diuretic prescriptions for patients who have a normal blood pressure up to 6 months” do not help the nurse identify the specific medication parameters necessary to provide good patient care. When in doubt, involve a pharmacist or prescriber to clarify incomplete protocols and standing orders.

8. Where can I obtain further information?

Controlled substance law:www.dea.gov

Prescribing law for CNSs and Nps :www.oregon.gov/osbn/pdfs

Oregon Board of Pharmacy:www.oregon.gov/pharmacy

Example of vaccine protocol:www.immunize.org/catg.d/p3078.pdf