Advance Practice Nurses Receive Green Light to Prescribe Schedule II Medications

September 19, 2018 by Robyn W. Madden

Counseling and Defending Licensed South Carolina Nurses 

South Carolina has placed an increased focus over the past couple of years related to pain management and prescribing controlled medication.  In late 2017, The Board of Medical Examiners, Board of Nursing, and Board of Dentistry issued revised pain management guidelines delineating what must be considered when prescribing controlled medications. The lines recently shifted to provide for increased discretion for prescribing practices.  In May 2018, Governor Henry McMaster expanded prescriptive authority, signing a bill into law granting nurse practitioners, certified nurse-midwives, and clinical nurse specialists the ability to prescribe Schedule II narcotic and non-narcotic medications subject to certain conditions and provided that the practice agreement (entered into by and between the practitioner and his/her supervising physician) provides for the same.  Prescribing and/or practicing outside of the guidelines set forth herein may result in LLR disciplinary action.

Drafting a Proper Practice Agreement

Any medical acts performed by a nurse practitioner or clinical nurse specialist must be conducted in accordance with a written practice agreement between the nurse and the physician or medical staff. In South Carolina, a practice agreement should include, at a minimum, the following information:

• name, address, and South Carolina license number of the nurse and the supervising physician;
• the nature and scope of the practice and the specific practice location for the nurse and the physician.
• Confirmation of how consultations will occur with the physician; allowance for an alternate physician as back-up, if the primary physician is not available.
• The date of the original agreement, the date of any amendments;
• Confirmation of the medical conditions for which treatment may be initiated, continued, or modified;
• Treatment that may be initiated, continued, or modified;
• Medication that may be prescribed;
• Any situations which require direct evaluation by, or referral to, the supervising physician and/or another medical provider.

When discretion is granted for prescriptive authority within the practice agreement, each prescription written must additionally:

• Comply with all applicable state and federal law and executive orders;
• Be limited to prescriptions within the nurse practitioner or clinical nurse’s specialty as set forth in the Practice Agreement.

Advanced Practice Prescribing of Controlled Medication

Advanced practiced nurses may continue to prescribe Schedules III through V controlled substances when set forth under the Practice Agreement.

Advanced practice nurses may now also prescribe Schedule II medications when provided under the practice agreement subject to the following limitations.

• Schedule II non-narcotic medication may not exceed a thirty- day supply and only if provided for under the practice agreement.
• Schedule II narcotic medication may be written when provided under the practice agreement. Prescriptions may not exceed a five-day supply.  A second prescription may not be written without the written agreement of the supervising physician unless the prescription is written for patients in hospice or palliative care.

Practicing beyond the scope of the agreement, or the extent of the new law, can result in disciplinary action with the South Carolina Board of Nursing.  Ensuring that a patient’s file is properly documented, and that your practice agreement is up to date and completely outlines the scope of the relationship is one way to limit potential liability.  Turner Padget’s Professional License Defense Team assists LPNs, RNs, APRNs, and CRNAs across the State of South Carolina. If you have questions about this article, or need assistance defending a Board of Nursing Complaint, call us today to learn more about how we can help.  803-227-4254