INSURANCE INSIGHTS Œ Before initiating treatment of intractable pain with controlled substances, the process of informed consent (PARQ) is mandatory and documentation of the process must be included as a permanent component of the medical record. OAR 847- 015-00302 requires the healthcare professional to discuss with the patient the Procedures, Alternatives and Risks associated with the prescribing of or administration of controlled substances for long-term management of pain. The patient should then be permitted to ask Questions or request further explanations. When the patient expresses satisfaction with the verbal explanation of the informed consent process, the healthcare professional must provide a written document to the patient outlining the issues discussed. The rule requires that the written document must contain information associated with the prescribed or administered controlled substance, which the patient must sign. » To fulfill the written documentation requirement noted above, the Oregon Medical Board (OMB) has created a sample PARQ/ Material Risk Notice (MRN). A link to the sample document is included at the end of this article. — Please note that this form is not the only type of form permitted and represents a sample that encompasses the requirements of OAR 847-015-0030. — If healthcare professionals opt to use a written document other than the OMB sample document, please refer to the list below for information that should be included in the document: x The diagnosis; x The controlled substance and/or group of controlled substances to be used; x Anticipated therapeutic results; x Pain relief; x Functional goals; x Alternatives to controlled substance therapy; x Potential additional therapies to be used in conjunction with the controlled substance; x Potential side effects; x Allergy potential; x Interaction of other medications; x Withdrawal precautions; x The potential for dependence and addiction; x The potential for impairment of judgment and/or motor skills; x Satisfaction with or desire for more explanation; and x Patient signature (dated). It is recommended that the informed consent (PARQ or MRN) document be signed on a yearly basis and whenever medication is changed. The informed consent document does not replace a pain agreement. Œ Pain or Treatment Agreements may be utilized to enhance patient understanding and continuity of care. Ensure that pain or treatment agreements are enforced and remain current, reflecting changes in medication dosages. Pain or treatment agreements also should address collaboration and mutual responsibilities between the patient and provider, such as: » Prescription refill parameters — One physician — One pharmacy — Refills only as scheduled, no early refills » Repercussions of non-compliance — Ensure that you have adequate policies and procedures in place for discharging patients with chronic pain from your care. Make sure that violations are clearly communicated to the patient and documented in the chart. Providers have the right to determine the patients they will treat if there is consistent use of established policies and procedures. A link to a sample pain agreement is provided below under “Resources” for your reference. If you have any questions regarding the information provided or other risk topics, please contact CNA Healthcare at (800) 341-3684. RESOURCES Oregon Medical Board pain management: http://www.oregon.gov/omb/Topics-of- Interest/Pages/Pain-Management.aspx. This link provides general information as well as the sample Material Risk Notice (MRN) form. Oregon Pain Guidance website (healthcare professional section): http://www. oregonpainguidance.com/healthcareprofessionals/. A sample Patient Treatment Agreement is available on this website. “Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain,” Journal of Pain, February 2009, Volume 10, Issue 2, Pages 113–130.e22. http://www. jpain.org/article/S1526-5900(08)00831-6/ fulltext. Oregon Prescription Drug Monitoring Program: http://www.orpdmp.com/. REFERENCES 1. Oregon Revised Statutes 677.470- 480, https://www.oregonlegislature.gov/ bills_laws/ors/ors677.html. 2. Oregon Administrative Rules 847-015- 0030, http://arcweb.sos.state.or.us/pages/ rules/oars_800/oar_847/847_015.html. w ww.TheOMA.org Winter 2016 33
OMA Medicine in OR Winter 2015 2016
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