by Flora Bessey, Pharm.D., CGP

Tell me if this scenario sounds familiar: a patient is admitted from the hospital for a short-term rehab stay. Within the long list of discharge meds is a C2 medication for pain control, and there is no triplicate from the discharging physician authorizing this medicine (as usual). Now, the facility begins to scramble to ensure that the resident’s pain is adequately managed…

First, call the attending at the facility; can we get an “emergency fill?” or can you come in to sign the paper work? This can certainly be an issue on weekends, after-hours, or holidays but many times during working hours! Note an emergency authorization given verbally to a pharmacist by the prescriber is good for 72 hours and can be filled for a maximum of a 7 day supply.

Now, we are coming up against the expiration of that emergency prescription, and perhaps the physician has not been into the facility to sign charts and/or continuance letters. What do we do now? In some cases, a creative pharmacist can call a physician and get him/her to authorize an additional “emergency fill” of the same pain medication as a different prescription (ex: the original order was “oxycodone 10mg q 4 hours PRN for pain.” A new order must be generated for another emergency fill, so the pharmacist asks the physician if a new order for “oxycodone 15 mg q 6 hours for pain” can be generated). Obviously, this is an imperfect solution!

So, what solutions are available to us that enable us to appropriately treat our residents who are in need of C2’s for pain control while abiding by the sometimes-onerous paperwork requirement? Luckily, thanks to the advances in EHR, there are many choices available that enable “electronic prescribing of controlled substances (EPCS).” Usually, a long-term care pharmacy that receives an electronic prescription request (via Point-Click-Care, or Matrix, for example) will fill the scripts, package them, and ship them to the facility. This process screeches to a halt if a C2 prescription arrives with no triplicate. A letter is (hopefully) generated and faxed to whatever phone number the doctor chooses, notifying him/her of the paperwork needed. The doctor would then have to fill out this paperwork IN HIS/HER OWN HANDWRITING, sign it, and fax it back to the pharmacy. Now, using the EPCS software, a physician can then send a “triplicate”-like message directly to the pharmacy, virtually instantaneously, without having to be present in the SNF.

In my research for this article, I examined a very helpful website, “surescripts.” This site has an exhaustive database of companies that will provide everything from an integrated EHR/EPCS software system (if the physician has a “hybrid” practice) to a very basis EPCS system with very limited EHR capabilities (for “SNFists”). The costs vary widely, but are not unreasonable; one company even offers their “solution” for free! The other companies that I researched usually charge a one-time “verification” fee ($85-$225), plus a monthly fee ($25-$399).

Prescribers, look into these options and decide if the improvement in customer service for our SNF’s/patients, convenience, and speed make these EPCS solutions an option for your practice.