INSURANCE INSIGHTS Pain Management Rules and Recommendations Controlled Substances for the Treatment of “Intractable Pain” By Michelle O’Neill, MN, MBA, PhD, CPHRM, CNA Healthcare Risk Control Consultant; and Melanie Spiering, CNA Healthcare Underwriting Director Risk management solutions from CNA Healthcare PAIN MANAGEMENT HAS BECOME an area of increased focus for healthcare professionals as pain is one of the most common reasons that patients seek medical care. In addition, increased concerns surrounding drug addiction, drug misuse, drug diversion and regulatory scrutiny have intensified the need of healthcare professionals to seek guidance when prescribing opioids for chronic or recurring pain. Moreover, inappropriate prescribing may lead to a healthcare professional liability claim or medical board investigation. Under Oregon law, healthcare professionals who are acting within the scope of practice of their license may prescribe or administer controlled substances in the course of treatment for a diagnosed condition causing pain, with the goal of controlling the patient’s pain for its duration (ORS 677.470-4801). State law allows controlled substances to be prescribed for long-term treatment of “intractable pain” as governed by the parameters set forth in the statute. The corresponding rule defines “intractable pain” as a chronic pain state in which the cause of the pain cannot be removed or otherwise treated and for which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain has been found after reasonable efforts, including, but not limited to, evaluation by the healthcare professional (OAR 847-015-00302). The following recommendations, in concert with the basic principles of sound professional practice, are intended to assist you in rendering quality patient care while minimizing the risks surrounding the prescribing of controlled substances for intractable pain. Evaluating the patient Œ Evaluate all pain with a thorough history and physical, including an assessment of psychosocial factors and family history. Re-evaluate the efficacy of the treatment plan at every visit. Œ An opioid risk assessment, depression scale testing and an assessment of the risk of abuse should be completed for each patient before opioids are prescribed. Thereafter, patients should be routinely screened. » Common risk of abuse factors to consider include, but are not limited to, 1) family history of alcohol or drug use, 2) history of physical or sexual abuse and 3) psychiatric conditions. » Commonly used screening tools include: 1) the opioid risk tool, 2) the Diagnosis, Intractability, Risk, Efficacy (DIRE) tool. 3) the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), and 4) the Screening Instrument for Substance Abuse Potential (SISAP). Refer to page 33 for a link to the Journal of Pain which has samples of these screening tools. Œ Evaluate the potential for misuse at every visit. Tools that healthcare professionals should embrace and utilize to aid in identifying misuse include, but are not limited to: » Random urine drug screening » Pill counts, and » Utilization of the Oregon State Prescription Drug Monitoring Program (PDMP) Documentation, Informed Consent, and Pain Agreements Œ Medical records must contain the healthcare provider’s examination, diagnosis and any other supporting diagnostic evaluations or other therapeutic trials, including records from previous providers. If there is a consulting physician, written documentation of his/her corroborating findings, diagnosis and recommendations should be included in the record. Œ Prescribe in a manner to avoid addiction, diversion, respiratory depression or other adverse effects. A dispensing record must be part of the patient’s medical record and must include: » Name of Drug » Dose » Quantity dispensed » Directions for use » Name of healthcare professional dispensing the drug 32 Medicine in Oregon www.TheOMA.org
OMA Medicine in OR Winter 2015 2016
To see the actual publication please follow the link above