NR 565 week 2 State Specific Guidelines for Prescribing Controlled Substances Medical Devices

Sample Answer

Student Name

State of Planned NP Clinical Practice: Florida

Complete the following table with information specific to the state where you plan to practice as a nurse practitioner. Please refer to the rubric in the course to identify how much each prompt is worth. Most are worth 5 or 6 points with one question being worth 10 points. The 10 point question is noted in the table.

• Sources should be obtained directly from the state’s regulatory organization(s) and must be cited appropriately.
• It is recommended that you keep a copy of this paper to provide to potential employers or your Board of Nursing in order to demonstrate your knowledge of your state laws.

Guidelines and recommendations for your state

In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following;

Provide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education.

Organization, group, or task force name:

• Florida Department of Health
• Florida Statutes

Where you found this information (weblink)

• https //www.floridahealth.gov/programs-and-services/non-opioid-pain-management/index.html
• https //m.flsenate.gov/statutes/464.012

Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note you may need to contact your state’s board of nursing, pharmacy, or medicine if you cannot locate it on your own).

Overview of your state’s guideline development with web address.

The Electronic-Florida Online Reporting of Controlled Substance Evaluation Program (E-FORCSE®), also known as the Florida Prescription Drug Monitoring Program, was established by the 2009 Florida Legislature to promote safer prescribing practices for controlled substances and mitigate drug abuse and diversion within the state. Dispensers contribute information on controlled substance dispensing to the database, which prescribers can then consult.

• https //flhealthsource.gov/FloridaTakeControl/pdmp/ Locate federal guidelines and provide a link to federal guidelines you could use in practice as a NP
• https //www.flsenate.gov/Committees/billsummaries/2018/html/1799# ~ text=Limiting%20a%20prescription%20for%20an,practitioner%20and%20with%20proper%20documentation.Paste the link here
• https //www.hhs.gov/opioids/prevention/pain-management-options/index.html

Some states have multiple organizations or initiatives (ex Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group’s recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention. Provide a brief overview of the group’s recommendations or initiatives (provide link to where you found information).

Florida’s State Opioid Response (SOR) Project is a federal grant administered through the Florida Department of Children and Families. Florida’s SOR project implements a comprehensive approach to addressing opioid and stimulant misuse, disorders, and overdoses.

• https //www.myflfamilies.com/services/samh/samh-treatment-services-and-facilities/fsorp# ~ text=Florida’s%20State%20Opioid%20Response%20(SOR,misuse%2C%20disorders%2C%20and%20overdoses.

Provide a brief overview of the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention (provide link to where you found information).

There are various strategies available to minimize opioid exposure and deter the development of opioid use disorder. These include the implementation of prescription drug monitoring programs, adherence to state prescription drug laws, and the application of formulary management tactics in insurance programs. Strategies like prior authorization, quantity limits, and drug utilization review contribute to more controlled opioid dispensing. Academic detailing serves to educate healthcare providers about opioid prescribing guidelines, fostering discussions with patients regarding the potential risks and benefits of pain treatment options.

Health care systems can also incorporate quality improvement programs to encourage the adoption of recommended prescribing practices. Patient education is crucial, emphasizing safe storage and proper disposal of prescription opioids. Increasing awareness about the risks associated with prescription opioids and sharing resources can help underscore the impact of overdose on patients and their families.

• https //www.cdc.gov/opioids/overdoseprevention/opioid-use-disorder.html

Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 10 points. 4 points for when opioids are appropriate, 4 points for a safe duration of use, and 2 points for a current edition APA formatted reference.)

Prescribers should use the lowest dose of opioids possible to start therapy (Dowell, D., 2022). “Acute pain” refers to the anticipated, normal, and time-limited physiological response to adverse chemical, thermal, or mechanical stimuli typically associated with surgical procedures, trauma, or acute illnesses (The Florida Senate, n.d.). It explicitly excludes pain associated with cancer, terminal conditions, palliative care for symptom relief in the context of incurable progressive illnesses or injuries, and significant traumatic injuries with an Injury Severity Score of 9 or higher (The Florida Senate, n.d.).

Opioids schedule II should be prescribed for acute pain for 3 days, if medically necessary it can be increased to 7 days (The Florida Senate, n.d.). Safe duration for the use of opioids should also include an evaluation of benefits and risk one to four weeks following initiation of opioid therapy and every three months or more for continued use patients. During evaluation, if the benefits do not outweigh the risks, therapies may need to be lowered, tapered, or discontinued. Prescribers should use the lowest dose of opioids possible to start therapy (Dowell, D., 2022).

• Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC clinical practice guideline for prescribing opioids for pain — United States, 2022. Recommendations and Reports Morbidity and Mortality Weekly Report, 71(3), 1–95. https //doi.org/10.15585/mmwr.rr7103a1
• The Florida Senate. (n.d.). Flsenate.gov. Retrieved November 12, 2023, from https //www.flsenate.gov/Committees/billsummaries/2018/html/1799.

State specific laws on controlled substance prescribing for the nurse practitioner
Research your state laws on advanced practice nurses’ authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following;

Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state.

Link to where you found law, rule, code, or statute for your state.

• https //m.flsenate.gov/statutes/464.012

What does the law, rule, code, or statute say?

Any nurse desiring to be licensed as an advanced practice registered nurse must apply to the department and submit proof that he or she holds a current license to practice professional nursing or holds an active multistate license to practice professional nursing pursuant to s. 464.0095

Discuss the provisions of the law, rule, code, or statute regarding the following;
Conditions or limits on prescribing schedule I-V controlled substances.

Opioids schedule II should be prescribed for acute pain for 3 days, if medically necessary it can be increased to 7 days.In the six months following the day the prescription was issued, a controlled substance designated in Schedule III, Schedule IV, or Schedule V may not be filled or refilled more than five times without a practitioner’s renewal.

It explicitly excludes pain associated with cancer, terminal conditions, palliative care for symptom relief in the context of incurable progressive illnesses or injuries, and significant traumatic injuries with an Injury Severity Score of 9 or higher.
Requirements (if any) in documentation for treating acute and chronic pain. If your state has no requirements for this, confirm with a link of where you found this information.

(a) Certification from a speciality board that is acceptable. As a certified nurse midwife, certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, or psychiatric nurse, such certification is necessary for both the initial state license and any licensure renewal. The board may, by rule, grant certified registered nurse anesthetists, clinical nurse specialists, certified nurse practitioners, psychiatric nurses, and certified nurse midwives temporary state licenses while they study for and take the national certification exam.

(b) Completing a master’s degree program in a clinical nursing specialty field with preparation in specific practitioner skills. (https //m.flsenate.gov/statutes/464.012)

Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance? Yes or No. Yes If yes, what are they? If not, how would they be helpful?

APRNs have to take an approved 3 hour course on Prescribing of controlled substances and continuing education on safe and effective prescribing controlled substances

• https //flhealthsource.gov/FloridaTakeControl/

State Prescription Drug Monitoring Program (PDMP)

Research your state’s PDMP* and provide the following information;

Name of the state’s program.

The Electronic-Florida Online Reporting of Controlled Substance Evaluation Program (E-FORCSE®), also known as the Florida Prescription Drug Monitoring Program
Website for the state PMDP. https //flhealthsource.gov/FloridaTakeControl/pdmp/

Discuss the registration requirements and process.

Each prescriber and dispenser or his or her designee has a duty to consult the PDMP system to review a patient’s controlled substance dispensing history each time a controlled substance is prescribed or dispensed to a patient age 16 or older unless a statutory exemption applies. Providers have to register at the PDMP at https //florida.pmpaware.net. It requires that every individual register as a separate user, using an email address as their username. You will then be prompted by the screen on what comes next. Select Your User Role Category, DEA and NPI numbers, if necessary, Healthcare Specialty is the official Healthcare Taxonomy Code description. Personal information, employer information, delegate registration, review your profile details and submit/continue if information is correct.

Discuss the standards and procedures for the access and review of database information.

Access E-FORCSE, view controlled substance history of a patient, prescribers should go to https //florida.pmpaware.net/ & login. Next, from the menu go to Rx Search & choose Patient Request. Then enter at least the patient’s first & last name, dob, & prescription fill dates. Click search at bottom of screen & patient report will populate. Select run report & the patient’s prescription history will populate.

State specific laws on medical devices prescribing for the nurse practitioner

Research your state laws on advanced practice nurses’ authority to prescribe medical devices. These are also called Durable Medical Equipment (DME). Based on research done on the state where you will practice clinically, include the following;

Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe medical devices or DME in your state.

• Florida Statue 499.015

Link to where you found law, rule, code, or statute for your state regarding prescribing DME in your state.

• http //www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0499/Sections/0499.015.html

What does the law, rule, code, or statute say regarding prescribing DME in your state?

• A DME license is required by the state of Florida for any person or company that sells durable medical equipment.
• A Level 2 background check will need to be passed by all who open a DME business in Florida.
• DME company must be able to work with insurance companies and directly with families to help them get the products they need and that their insurance will pay for.

Discuss the provisions of the law, rule, code, or statute regarding the following;

Conditions or limits on prescribing medical devices or DME.

Per CMS, 2022
A nurse practitioner or clinical nurse specialist may give the dispensing order and sign the detailed written order when;

• They meet the definition of nurse practitioner or clinical nurse specialist found in §1861(aa)(5)(A) and §1861(aa)(5)(B), respectively.
• They are treating the beneficiary for the condition for which the item is needed.
• They are practicing independently of a physician.
• They bill Medicare for other covered services using their own provider number.
• They are permitted to do all of the above in the State in which the services are rendered.

Requirements (if any) in documentation needed to support order of medical devices or DME.

For all items requiring a face-to-face encounter, a practitioner visit is required within six months preceding the order. Note face-to-face encounters for PMDs were previously required within 45 days preceding the written order.

Supporting documentation with subjective and objective information associated with diagnosing, treating, or managing a clinical condition for which the DMEPOS is ordered.

• Se, M. M. N., & N/a, R. C. R. (n.d.). What suppliers need to know about orders for DMEPOS items. Cms.gov. Retrieved November 13, 2023, from https //www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18009.pdf