Pennsylvania Code › Title 49 - PROFESSIONAL AND VOCATIONAL STANDARDS › Part I - DEPARTMENT OF STATE › Subpart A - PROFESSIONAL AND OCCUPATIONAL AFFAIRS › Chapter 21 - STATE BOARD OF NURSING › Subchapter C - CERTIFIED REGISTERED NURSE PRACTITIONERS › CRNP PRACTICE › Section 21.284b - Prescribing, administering and dispensing controlled substances

Current through Register Vol. 54, No. 28, July 13, 2024
(a) A CRNP
						authorized to prescribe or dispense, or both, controlled substances shall
						register with the Drug Enforcement Administration.
(b) A CRNP shall carry out the following
						minimum standards when prescribing, administering or dispensing controlled
						substances:
(1)
Initial
						evaluation.
In a health care facility regulated by the Department of
						Health, the Department of Public Welfare or the Federal government, an initial
						medical history shall be taken and an initial physical examination shall be
						conducted to the extent required by the Department of Health in 28 Pa. Code
						(relating to health and safety) or Department of Public Welfare in 55 Pa. Code
						(relating to public welfare) or the Federal government in appropriate Federal
						regulations, whichever is applicable, and bylaws of the health care facility
						and its medical staff. In other practice settings, before commencing treatment
						that involves prescribing, administering or dispensing a controlled substance,
						an initial medical history shall be taken and an initial physical examination
						shall be conducted unless emergency circumstances justify otherwise.
						Alternatively, medical history and physical examination information recorded by
						another health care provider may be considered if the medical history was taken
						and the physical examination was conducted within the immediately preceding 30
						days. The physical examination must include an evaluation of the heart, lungs,
						vital signs, pain level, and body functions that relate to the patient's
						specific complaint.
(2)
Reevaluations.
Among the factors to be considered in
						determining the number and frequency of follow-up evaluations that should be
						recommended to the patient are the condition diagnosed, the controlled
						substance involved, expected results and possible side effects. For chronic
						conditions, periodic follow-up evaluations shall be recommended to monitor the
						effectiveness of the controlled substance in achieving the intended
						results.
(3)
Patient
						counseling.
Appropriate counseling shall be given to the patient
						regarding the condition diagnosed and the controlled substance prescribed,
						administered or dispensed. Unless the patient is in an inpatient care setting,
						the patient shall be specifically counseled about dosage levels, instructions
						for use, frequency and duration of use and possible side effects.
(4)
Medical records.
In a
						health care facility regulated by the Department of Health, the Department of
						Public Welfare or the Federal government, information pertaining to the
						prescription, administration or dispensation of a controlled substance shall be
						entered in the medical records of the patient and the health care facility
						under 28 Pa. Code or 55 Pa. Code or appropriate Federal regulations, whichever
						is applicable, and bylaws of the health care facility and its medical staff. In
						other practice settings, certain information shall be recorded in the patient's
						medical record on each occasion when a controlled substance is prescribed,
						administered or dispensed. This information must include the name of the
						controlled substance, its strength, the quantity and the date it was
						prescribed, administered or dispensed. On the initial occasion when a
						controlled substance is prescribed, administered or dispensed to a patient, the
						medical record must also include a specification of the symptoms observed and
						reported, the diagnosis of the condition for which the controlled substance is
						being given and the directions given to the patient for the use of the
						controlled substance. If the same controlled substance continues to be
						prescribed, administered or dispensed, the medical record must reflect changes
						in the symptoms observed and reported, in the diagnosis of the condition for
						which the controlled substance is being given and in the directions given to
						the patient.
(5)
Emergency
						prescriptions.
In the case of an emergency contact by a known patient,
						a prudent, short-term prescription for a controlled substance may be issued.
						Neither a refill nor a consecutive issuance of this emergency prescription may
						be given unless a physical examination and evaluation of the patient are first
						conducted. The results of this examination and evaluation must be set forth in
						the patient's medical record together with the diagnosis of the condition for
						which the controlled substance is being prescribed. An emergency oral
						prescription for a Schedule II controlled substance shall be covered by a
						written prescription delivered to the pharmacist within 72 hours. In certain
						health care facilities regulated by the Department of Health, the Department of
						Public Welfare and the Federal government, an order for the immediate, direct
						administration of a Schedule II controlled substance to a patient is not
						considered a prescription and is, therefore, not subject to the requirements in
						this paragraph. Further information regarding this exclusion can be found in
						The Controlled Substance, Drug, Device and Cosmetic Act (35 P.S.
						§§
														780-101-780-144) and 28 Pa. Code
						Chapter 25 (relating to controlled substances, drugs, devices, and
						cosmetics).