Innovations In Clinical Neuroscience

MAR-APR 2018

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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47 ICNS INNOVATIONS IN CLINICAL NEUROSCIENCE March-April 2018 • Volume 15 • Number 3–4 Prescribing Controlled Substances: Managing the Risks by DONNA VANDERPOOL, MBA, JD Ms. Vanderpool is Vice President, Risk Management at PRMS, Inc. in Arlington, Virginia. Innov Clin Neurosci. 2018;15(3–4):47–51 Risk Management QUESTION With everything going on in the news about the opioid epidemic and the accusations of the prescribing practices of physicians contributing to the abuse and diversion of drugs, and even patient deaths due to overdose, I'm considering no longer prescribing controlled substances, or at least those in Schedule II. Am I overreacting? ANSWER In our current environment, it is understandable for prescribers to be wary of the increased risk of governmental scrutiny and allegations of malpractice. Fortunately, even in light of this increased scrutiny, providing appropriate clinical care remains the best way to reduce and manage risk, and there are proven strategies to assist you in providing appropriate clinical care. RISK MANAGEMENT OVERVIEW—THE THREE CS Effective risk management strategies that mirror best clinical practices and decrease risk related to prescribing controlled substances are represented by the three Cs: • Collecting information—about the medication, patient, treatment and standard of care, and abuse and diversion • Communicating—with the patient and others • Carefully documenting—the patient's informed consent, medication monitoring, and your decision-making process. These three risk management strategies are not meant to oversimplify the practice of psychiatry and the complexities related to decreasing adverse drug events. Rather, they are presented as a way to organize and more easily use the strategies shown to be effective in minimizing risks when prescribing controlled substances. RISK MANAGEMENT STRATEGY #1— COLLECTING INFORMATION Collecting information about medications . Staying current about medications being prescribed is fundamental to prescribing, but it's no small task. It is more challenging than ever to stay current about prescription drugs because of the amount of information being produced, the speed at which it develops, and the prevalence of conflicting and/or incomplete information. Important activities on which to stay up to date include, but are not limited to, the following: • Reading the United States Food and Drug Administration (FDA) label for the medications you prescribe • Subscribing to the FDA's MedWatch E-list 1 for notification of medication safety alerts This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (, a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members. FUNDING: No funding was provided for the preparation of this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Donna Vanderpool, MBA, JD; Email:

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