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Narcotic Pain Management Policy

Narcotic Pain Management Policy

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Published by JuanCarlos Yogi
Narcotic Pain Management Policy
Narcotic Pain Management Policy

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Published by: JuanCarlos Yogi on Oct 26, 2012
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Section: AGNNumber:Chapter:Originated: 6/08Last Reviewed: 6/08Title: Narcotic Pain Management PolicyApproved: P KullbergContact: Susan Kirchoff 
Patients Rights:1.Considerate and respectful care that accepts and acts upon reports of pain2.Thorough assessment and management of pain regardless of cause or severity3.Full disclosure of diagnosis and prognosis of condition, proposed treatments andtheir benefits, risks and costs4.Full participation in decisions about pain management, including the right to refusespecific treatments5.Privacy concerning all aspects of carePatient Responsibilities1.Participate in and cooperate with all aspects of pain care2.Refrain from all alcohol and drug use or abuse3.Disclose all alcohol or drug use, past or current4.Disclose all visits to emergency rooms or other providers, including mentalhealth providers5.If on probation or parole, sign a release of information to parole or probationofficer 6.Keep all appointments and adhere to the schedule of refills agreed upon with provide7.Comply with all provider dosing recommendations8.Agree to regular and random pill counts9.Agree to regular and random urine drug screens10.Refrain from giving pain medications away to others or borrowing painmedications from others11.Obtain pain medicine prescriptions only from the primary care provider or covering provider at the same clinic New patients:1.Low risk for abuse and/or diversion: provider to manage at his/her discretion (seeOpiate Risk Tool)2.Moderate or high risk for abuse and/or diversion (see Opiate Risk Tool) odischarged from or left other health care systems because of problematic behaviors:
Must be enrolled in nurse case management for pain (See Opiate Risk Tool andPain Management Protocol below)
Restrict to MCHD pharmacy for easier oversight of prescriptions, unless thisrepresents a hardship for the patient3.Patient with documented instances of selling drugs (an absolute contraindication)should not be considered for narcotic pain management4.Patients with documented history of intentional or unintentional overdose of narcotics requiring emergency intervention and patients with documented history of  prescription forgery for their own use are not good candidates (relativecontraindication) for narcotic pain management. If narcotics are prescribed, thesehigh risk patients must be enrolled in nurse case management and other controlsshould be considered such as bubble-packing, daily dispensing, etc.Transfer of Established patientsPatients, who have a pain management agreement, are dissatisfied with care or have problematic behaviors and who want to transfer to another provider or another clinic withinMCHD:
Avoid changing the patient’s medical home
Prior to transfer, if possible, refer case to clinic management and to OpiateOversight Committee (see below)
Clinic manager should counsel patient that current pain managementregimen will be continued by new provider, pending recommendations fromOpiate Oversight Committee.
Many of these patients will simply show up in the new PCP practice; refer  patient to Opiate Oversight Committee at that time
 New PCP may consider “fresh start” if:1.systems issues interfered with appropriate care of patient in prio practice (for example, patient denied meds because old records were never received, but ROI process was never completed by staff)2.patient condition or circumstances have substantially changed (foexample, patient successfully graduated from drug treatment program)
If new PCP grants fresh start, the patient must be enrolled in nurse casemanagement and restricted to MCHD pharmacy
Dissatisfied patients may elect to submit an appeal to the opiate oversightcommitteeCross Coverage1.When PCP is absent, covering provider will honor refill requests for narcotic painmedications if:
Pain medication agreement is in record
 No violations of the agreement are apparent
Refill due date is clearly documented2.Covering provider may elect to:
Give partial prescription pending PCP return
Order UDS
Deny refill for any of above conditionsPrescriptions and Refills1.Narcotic prescription on a first visit is at provider discretion (it isacceptable to request a ROI and/or copies of medical records before prescribing).2.A narcotic prescription on a first visit may be appropriate if the patientis low risk and sufficient documentation is available to ensure that there is nohistory of prior problem behaviors3.Prescribing narcotics at a first visit for a patient who might be at risk fowithdrawal must be weighed against the risk of abuse and/or diversion4.Lost or stolen narcotics will not be replaced5.Early refills should be avoided, but may be given at PCP discretion focompelling reasons. PCP should document the reason for the early refill anddocument on the prescription the appropriate date for the next refill. PCP shouldalso advise patient that early refills will not be given on a routine basis. will not begiven6.Refills will not be given after normal clinic hours, on weekends oholidays7.All refills must be obtained through a single designated pharmacy8.All refills must be obtained through the PCP or in his/her absence, the practice partne9.Refill requests submitted after 12 pm on Fridays may not be authorizeduntil the following work day10.Dosing adjustments will be made only by the PCP unless s/he is on a prolonged leave of absence (>= four weeks)11.All prescriptions will be written for 28 day cycles and scheduled to falldue on a day when PCP is normally in clinic12.Authorize no more than 2 (original plus 2) refills total for Schedule IIInarcotics and only for low risk patients13.Up to three 28 day prescriptions for Schedule II narcotics can be writtenon the same date with instructions to be filled at later dates, per established EHR  protocol, only for low risk patients. Pre-dated prescriptions which are lost or stolenmay not be replaced.14.Patients on chronic narcotics should be seen by the nurse or PCP at leastevery 3 months and by the PCP at least every 6 monthsOpiate Oversight Committee1.The purpose of the Opiate Oversight Committee is to review cases and makerecommendations for clinical management of chronic pain patients taking opiate pain medications or who wish to take opiates. Providers/Provider Team may refer to the Committee any patient for whom they wish a second opinion on the best

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