La. Admin. Code tit. 46 § LIII-2511

Current through Register Vol. 50, No. 9, September 20, 2024

Section LIII-2511 - Prescriptions and Chart Orders

A. Definitions. As used in this Chapter, the following terms shall have the meaning ascribed to them in this Section:

Chart Order-a lawful order entered on the electronic or paper chart or medical record of an inpatient or resident of an institutional facility by a practitioner or his licensed healthcare designee for a drug or device and shall be considered a prescription drug order provided it contains the following:

1. full name of the patient;

2. date of issuance;

3. name, strength, and dosage form of the drug prescribed;

4. directions for use;

5. name of the prescribing practitioner;

6. the prescribing practitioner's written or electronic signature or the written or electronic signature of the practitioner's licensed healthcare designee, who shall be a licensed nurse, pharmacist, or physician practicing in a long-term care facility. The licensed healthcare designee shall be authorized to document a chart order in the patient's medical record on behalf of the prescribing practitioner pending the prescribing practitioner's signature, or to communicate a prescription to a pharmacy whether telephonically, by facsimile transmission, or electronically.

Electronic Prescription-a prescription generated, signed, and transmitted in electronic form, excluding electronically transmitted facsimile documents.

Practice Affiliation-repealed.

Practitioner-an individual currently licensed, registered, or otherwise authorized by the appropriate licensing board to prescribe and administer drugs in the course of professional practice.

Prescription or Prescription Drug Order-an order from a practitioner authorized by law to prescribe for a drug or device that is patient specific and is communicated by any means to a pharmacist in a permitted pharmacy, and is to be preserved on file as required by law or regulation.

B. Patient Authority to Acquire Prescription Drug or Device

1. A prescription or chart order represents the lawful authority for a patient, or his agent or caregiver, to acquire a prescription drug or device from a pharmacy licensed to dispense prescription drugs and devices.

2. In the absence of refill instructions on the original prescription, the prescription shall not be refilled. A pharmacist, using his professional judgment, may dispense the total quantity authorized in one transaction, or in the alternative, may dispense partial quantities in multiple transactions, provided however, that the sum of the partial quantities shall not exceed the total quantity authorized.

3. In the event a prescription contains refill instructions, the prescription may be refilled when requested by the patient, or his agent or caregiver. A pharmacist, using his professional judgment, may dispense the quantity authorized for each refill in a single transaction, or in the alternative, may dispense partial quantities in multiple transactions, provided however that the sum of the partial quantities shall not exceed the total quantity authorized.

4. While the documentation of a prescription or chart order shall be retained by the dispensing pharmacy as evidence of its lawful dispensing of the prescription drug, the patient's lawful authority to obtain the drug conveyed by the prescription or chart order shall continue to exist until the earliest of the expiration date of the prescription or chart order, or in the alternative, when the total quantity authorized has been dispensed.

5. In the event a patient, or his agent or caregiver, requests a pharmacy to transfer an unfilled prescription for a medication not listed as a controlled substance to another pharmacy, the pharmacy shall comply with that request as soon as possible, but no later than the end of the next business day.

6. In the event a patient, or his agent or caregiver, requests a pharmacy to transfer the remainder of an unexpired prescription to another pharmacy, the pharmacy shall transfer that prescription information in compliance with the provisions of this Chapter as soon as possible but no later than the end of the next business day. Prior to such transfer, a pharmacy shall not cancel the remainder of an unexpired prescription unless such action is required by law or rule or is requested by the prescriber.

C. Persons Authorized to Issue Prescriptions and Chart Orders

1. A prescription for a drug or device may be issued by a practitioner with valid prescriptive authority.

2. A prescription may be prepared by the agent of the prescriber for the signature of the prescriber, but the prescriber retains accountability for the proper issuance of a valid prescription. A prescriber's agent may communicate a valid prescription to a pharmacy.

3. A pharmacist may issue a prescription when so authorized by law, rule, standing order, or practice agreement.

D. Required Information

1. A prescription shall contain the following data elements:

a. prescriber's name, licensure designation, address, telephone number, and if for a controlled substance, the Drug Enforcement Administration (DEA) registration number;

b. patient's name, and if for a controlled substance, address;

c. date prescription issued by the prescriber;

d. name of drug or device, and if applicable, strength, and quantity to be dispensed;

e. directions for use;

f. signature of the prescriber; and

g. refill instructions, if any. In the absence of refill instructions on the original prescription, the prescription shall not be refilled.

2. In the event a pharmacist receives a prescription or chart order lacking certain required information, the pharmacist, pharmacy intern or certified pharmacy technician may consult with the prescriber or his agent to clarify the prescriber's intent.

E. Manner of Issuance

1. Oral Prescriptions

a. Upon the receipt of an oral prescription from an authorized prescriber, the pharmacist or pharmacy intern or pharmacy technician shall reduce the order to a written form prior to dispensing the medication. As an alternative to recording such prescriptions on paper forms, a pharmacist may enter the prescription information directly into the pharmacy's dispensing information system.

b. In the event a pharmacy intern or pharmacy technician transcribes such a prescription, the supervising pharmacist shall initial or countersign the prescription form prior to processing the prescription.

2. Written Prescriptions. A written prescription shall conform to the following format.

a. The prescription form shall be of a size not less than 4 inches by 5 inches, and shall bear a single printed signature line.

b. The prescription form shall clearly indicate the authorized prescriber's name, licensure designation, address, telephone number, and if for a controlled substance, the Drug Enforcement Administration (DEA) registration number. In the event that multiple practitioners are identified on the prescription form, the authorizing prescriber's specific identity shall be clear and unambiguous. This identification may be indicated by any means, including but not limited to, a marked check box next to, or circling, the authorized prescriber's printed name.

c. No prescription form shall contain more than four active prescription drug orders. Each active prescription drug order on the form shall provide the following:

i. check box labeled "Dispense as Written", or "DAW", or both; and

ii. the number of refills, if any.

d. The prescription shall be written with ink or indelible pencil, typewriter, or printed on a computer printer and shall be manually signed by the practitioner on the date issued and in the same manner as he would sign a check or legal document (e.g., J. H. Smith or John H. Smith). Examples of invalid signatures include rubber stamps, signatures of anyone other than the prescriber, and computer-generated signatures.

e. Receipt via Facsimile

i. Pharmacies may elect to receive written prescriptions via a facsimile machine located within the prescription department. The paper used to print such prescriptions shall produce a non-fading image. The pharmacy may elect to scan such documents in compliance with §1123 of this Part.

ii. Pharmacies may elect to receive written prescriptions via electronic facsimile directly within their pharmacy information system. The pharmacy shall retain such records in compliance with Section 1123 of this Part.

f. Chart orders and forms used by pharmacists to record telephoned or transferred prescriptions are exempt from the format requirements listed in this Section.

3. Electronic Prescriptions

a. The prescription shall clearly indicate the authorized prescriber's name, licensure designation, address, telephone number, and if for a controlled substance, the DEA registration number.

F. Prescription Adaptation

1. With the consent of the patient, or his agent or caregiver, a pharmacist may adapt a prescription drug order or chart order unless the prescriber has indicated adaptation is not permitted, subject to the following limitations:

a. A pharmacist may change the quantity of medication prescribed if:

i. the prescribed quantity or package size is not commercially available;

ii. the change in quantity is related to a change in dosage form;

iii. the change is intended to dispense up to the total amount authorized by the prescriber; or

iv. the change extends a maintenance drug for the limited quantity necessary to coordinate a patient's refills in a medication synchronization program.

b. A pharmacist may change the dosage form of the medication prescribed if it is in the best interest of patient care; however, the pharmacist shall modify the prescriber's directions to ensure an equivalent amount of the medication prescribed is dispensed.

c. A pharmacist may add information missing on the prescription drug order or chart order if there is evidence to support the change.

2. A pharmacist who adapts a prescription drug order or chart order shall document the adaptation in the patient's record.

La. Admin. Code tit. 46, § LIII-2511

Promulgated by the Department of Health and Hospitals, Board of Pharmacy, LR 14:708 (October 1988), effective January 1, 1989, Amended LR 29:2102 (October 2003), effective January 1, 2004, LR 4198 (1/1/2015), LR 412147 (10/1/2015), Amended by the Department of Health, Board of Pharmacy, LR 432162 (11/1/2017), Amended by Department of Health, Board of Pharmacy, LR 46585 (4/1/2020), Amended LR 471644 (11/1/2021), Amended LR 491722 (10/1/2023).

AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1182.