Nurses call for change in prescription drug law

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HEALTH CARE
Nurses call for change in prescription drug law 

Cleveland Clinic advanced practice nurse Jacalyn Golden is leading the charge calling for change to Ohio law that restricts an APN’s ability to prescribe highly controlled substances, such as Percocet. Photo credit: JASON MILLER + PHOTO ZOOM

RELATED LINKS Ohio Association of Advanced Practice Nurses Ohio State Medical Association

By ZACHARY LEWIS

4:30 am, July 2, 2007

It’s 2:30 a.m. You’re an advanced practice nurse on staff at an acute care facility somewhere in Ohio. One of your patients wakes up, crying out with pain.

Your instinct, naturally, is to alleviate that pain. But it’s Sunday morning, and the 24-hour Percocet prescription you prescribed for the patient on Friday just expired, and state law forbids a refill.

At this point, the only way you can give her the medicine is to get approval from the patient’s physician.

Some say that’s exactly how it should be, and Ohio law backs up that sentiment. Others — including thousands of nurses — believe it’s time for a change.

Leading the latter cause is Jacalyn Golden, who works for the department of advanced practice nursing at the Cleveland Clinic.

As chairwoman of the legislative committee of the Ohio Association of Advanced Practice Nurses, she’s spearheading an effort to make Ohio the 32nd state in which advanced practice nurses (APNs) have the ability to prescribe Percocet and other highly controlled substances, without going through a doctor. APNs are registered nurses who have received post-graduate education to give advanced clinical care.

Currently, APNs are allowed to prescribe such drugs, but with limitations: only in 24-hour increments and with approval from the physician who initiated the medication. 

The arrangement, Ms. Golden said, is “kind of ridiculous. … People who work up in intensive care, (seeing patients) with severe pain … they have to interrupt the surgeons to be able to prescribe, even though it’s well within their training.” 

The Ohio State Medical Association, a membership organization advocating on behalf of physicians, is the Ohio Association of Advanced Practice Nurses’ primary opponent. 

They argue that nurses, even APNs, aren’t sufficiently trained to diagnose independently within Schedule II, the contentious class of drugs that includes potentially addictive pain relievers such as fentanyl and attention deficit disorder medications such as Ritalin. (There’s no argument over APNs prescribing less-risky drugs in Schedules III through V.)

“Having the authority to prescribe for those drugs should really be guarded,” said Tim Maglione, the state medical association’s senior director of government relations. To give APNs the authority would “blur the line between the practice of medicine and the profession of nursing.”

Mr. Maglione said there is particular concern over whether APNs could prescribe medication in retail clinics or pharmacies. As for the bill, Mr. Maglione says the association hopes to work with the nurses for a “compromise.”

Ms. Golden is devoted to promoting Ohio House Bill 253, which would remove the restrictions and make Schedule II prescriptions a collaborative process between the APN and an Ohio Board of Nursing prescriptive governance committee, composed of physicians, pharmacists and other nurses.

Contained within the bill is language empowering the nursing board’s committee to determine which Schedule II substances a qualified APN can prescribe and under what circumstances. 

The Ohio bill, sponsored by Rep. Scott Oelslager, R-North Canton, is co-sponsored by several other representatives and has support from several major health care institutions around the state, including the Cleveland Clinic and University Hospitals Health System, Ms. Golden said.

The bill, introduced May 31, has been assigned to the health committee, according to the Ohio Legislative Service Commission. It will be taken up again in the fall. If approved, it would then go to the Ohio Senate.

Lisa Emrich, manager of education and practice at the Ohio Board of Nursing, said the proposed change is rather small. “(APNs) already have the ability to care for these types of patients within their own practices,” she said. “There’s already quite a bit of oversight.