Download -handouts

9/29/2015
SPEAKERCASES&PRACTICEPEARLS
ControversiesinPainManagement:
MisconceptionsinPainManagement
–
CriticalLegalIssues
Presented by: Jennifer Bolen, JD CasesandQuestions
• 1. Which federal agency is in the process of adopting a set of controlled substance prescribing guidelines for chronic pain care?
•
•
•
•
•
A. Drug Enforcement Administration
B. Food and Drug Administration
C. Centers for Disease Control and Prevention
D. Substance Abuse Mental Health Services Administration
E. None of the above
• THE CORRECT ANSWER IS “C” – the Centers for Disease Control and Prevention
CasesandQuestions:
Physician encounters a new patient who has an accepted medical need for the use of opioids to treat a medical condition causing chronic pain. The new patient also has a history of sleep apnea. What steps should the physician take to accomplish a proper INFORMED CONSENT with the patient? •A. Give the patient a Narcotic Contract and have him/her sign it. •B. Get a signed Narcotic Contract and tell the patient that opioids may aggravate his/her sleep apnea problem. •C. Educate the patient on the risk of overdose potential when combining opioids with a condition like sleep apnea. Give the patient the opioid overdose toolkit. Document the informed consent discussion. Consider prescribing a naloxone kit and educate patient on same. 1
9/29/2015
CASES&QUESTIONS
• From a medico‐legal perspective, a patient may be viewed as “at‐risk” for opioid overdose when: • A. The patient has a medical condition that impacts the respiratory system, such as sleep apnea. • B. The patient uses alcohol. • C. The patient uses a benzodiazepine.
• D. The patient uses long‐acting medication. • E. A, C, and D only. • F. A through D. • The correct answer is “F”
PEARLS
After attending this lecture, practitioners will be able to: 1.Identify the critical points of the CDC’s forthcoming opioid guidelines, and create an action plan to monitor the CDC’s website for the final guidelines and ideas on implementing them into medical practice. 2.Improve patient communications and informed consent practices through the introduction of the Opioid Overdose Toolkit for Prescribers and Patients/Family Members. 3.Improve documentation of Opioid Overdose Risk Evaluation. 4.Create a handbook of critical federal and state materials relating to minimizing risk of overdose, abuse, and diversion, and complying with developing guidelines on prescribing chronic opioid therapy.
Post‐LectureQuestion
• Informed Consent is a Process, which involves an initial and ongoing discussion between the physician and the patient about which of the following topic areas regarding each form of treatment ordered/prescribed?
• A. Use of a single pharmacy and single provider for controlled medications. • B. The risks, benefits, special issues, and treatment alternatives about each of the medications prescribed. • C. The use of FDA educational forms, to effect education on challenging topics such as use of methadone and urine drug testing. • D. None of the above. 2
9/29/2015
Post‐LectureQuestion
• When educating patients about drug safety, which answer best reflects the areas of education most related to the concept of informed consent?
• A. Education on urine drug screens and PDMP usage. • B. Education on safe use, safe storage, safe disposal of controlled medication, and opioid overdose criteria and prevention.
• C. Education on consequences if the patient fails to keep the promises made in his/her Narcotic Contract. • D. Education on how to find another provider in the event of a discharge or termination of care.
• The correct answer is “B” – Safe use, safe storage, and safe disposal covers a broad range of topics that relate to the process of informed consent. The “safe use” category explains much of the risk‐related and special issues items, and is therefore most closely aligned with informed consent duties. The “safe storage and safe disposal areas” fall under “special issues” associated with the use of opioids, but fairly may cross over to Opioid Contract language as well. Education on evaluating the potential risk for and signs of opioid overdose is viewed as critical by licensing boards and law enforcement, and consumer oriented agencies. 3