DEA regulations will impact nursing home residents, says AAHSA

Mar 25 2010

In written testimony to the U.S. Senate Special Committee on Aging as part of a hearing entitled, "The War on Drugs Meets the War on Pain: Nursing Home Residents Caught in the Crossfire," the American Association of Homes and Services for the Aging (AAHSA) urged the committee to support legislation designed to recognize "chart orders" and the functional role of nurses as the de facto agent of physicians whose patients reside in nursing facilities.

In its testimony, AAHSA outlined the effect that the U.S. Drug Enforcement Administration's (DEA) outdated and overly cumbersome regulations have on nursing homes residents' quality of care and life. The regulations prohibit pharmacists from filling prescriptions for controlled substances like many pain medications unless the pharmacy has a signed prescription from a physician. This additional step means that nursing home residents may be forced to wait hours, or even days, to receive medication for pain, seizures, psychiatric and end-of-life symptoms at times when physicians are hard to reach. 

Unlike hospital physicians, approximately 40 percent of physicians working in long-term care serve multiple facilities, do not maintain an office-based practice and consult with nurses via telephone if a resident's needs change quickly. As a result, nurses play a vital role in communicating information to physicians about residents under their care. They record physicians' verbal orders and ensure they are carried out while monitoring the residents' conditions.  That includes providing pain medication for residents who need it.

In this case, a  nurse records the physician's verbal order in the resident's clinical record, creating what is known as a "chart order," and faxes it to a long-term care pharmacy for dispensing. Through this process, nurses ensure that medications are acquired on a timely basis to meet residents' changing and emergent medical needs.

But because of the DEA regulations, controlled substances cannot be filled based on chart orders. Medication delays can place the residents at risk for rehospitalization and violate quality of care standards.  If a resident is harmed because of this delay, a facility can be fined or decertified, resulting in the loss of federal funding and, ultimately, closure.

The DEA's actions also put nurses in a "Catch-22" situation: either risk their professional license by documenting and following the attending physician's verbal order to provide pain medication or comply with DEA regulations and violate professional standards of practice and as well as pain management regulatory requirements for nursing homes.

In short, the DEA's regulations result in unnecessary pain and suffering by the frail and elderly and place providers in the unfathomable position of choosing  between good clinical practice and complying with a mandate that is completely contrary to both their own mission and to the regulatory structure under which they are certified to serve. These administrative barriers are a classic example of a breakdown in communications between federal agencies that leaves nursing home residents in the middle with little or no recourse. 

"We look forward to working with Congress and the DEA to rectify this inexcusable situation for nursing home residents," said Larry Minnix, AAHSA president and CEO. "There is a relatively simple fix available, and it will make an enormous difference in the quality of care and the quality of life of many nursing home residents."

A full copy of the testimony is available on AAHSA's Web site, www.aahsa.org.