4/12/2018. Disclosure Statement of Financial Interest

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1 Consultant/Over Prescribing Team 4/12/2018 Tennessee Chronic Pain Guidelines and Controlled Substance Efforts Symposia Linda Johnson, DNP APRN Consultant/Over Prescribing Team Disclosure Statement of Financial Interest I, Linda Johnson, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. Welcome Course Objectives: Be able to list where to find the BON website Be able to find where to find the rules that guide a supervising physician Be able to screen their patients for substance use disorders (SUD) 1

2 Licensure Data LPN RN RNFA APRN TOTAL ACTIVE 30, , , ,143 APRN Licensed in Tennessee CNS CRNA CNM CNP TOTAL Authority to Prescribe No Authority to Prescribe 127 1, ,688 12, , ,321 Total 142 2, ,737 12,704 Licensure Data Physician Assistants (PA) 2,238 2

3 Accessing the Board of Nursing Website TN.Gov/ health Health Professionals Health Professional Boards Choose Board (BON, BME, or PA) APRN Statues & APRN Rules pdf TN Chronic Pain Guidelines Guidelines.pdf CDC Guidelines APRN Statutory Requirements Protocols regarding prescribing required between APRN and collaborative physician at practice site Collaborative Request on file with Nursing Board (On Line) Formally known as Notice and Formulary Change in Collaborative Request (Notice and Formulary) within 30 days Two hour CE to include Chronic Pain Guidelines Prescriptions written by a nurse practitioner shall be deemed to be that of the nurse practitioner 3

4 PA Statutory Requirements Protocols regarding prescribing required between PA and collaborative physician at practice site Collaborative Request on file with PA Board (On Line) Formally known as Attachment 4 & 5 Change in Collaborative Request within 15 days (All other changes 30 days) Two hour CE to include Chronic Pain Guidelines Prescriptions written by a PA shall be deemed to be that of the PA Physician s Who Supervise APRNs & PAs Protocols Jointly approved, written, signed, on site Collaborative Agreement Charts signed every 30 Days (20%/100%) Site visit every 30 days Licensed within same specialty Buprenorphine CARA Act: Section 303. Medication Assisted Treatment for Recovery from Addiction: Expands prescribing privileges to nurse practitioners (NPs) and physician assistants (PAs) for five years (until October 1, 2021). Can APRNs and PA prescribe Buprenorphine? 4

5 TN Law Why TN: Use of buprenorphine products. (c) (1) Notwithstanding any other provision of this title, a physician licensed under title 63, chapter 6 or 9, is the only healthcare provider authorized to prescribe any buprenorphine product for any federal food and drug administration approved use in recovery or medication assisted treatment. Why Federal Law Section 303. Medication Assisted Treatment for Recovery from Addiction: This section makes several changes to the law regarding office based opioid addiction treatment with buprenorphine. Specifically, it: Expands prescribing privileges to nurse practitioners (NPs) and physician assistants (PAs) for five years (until October 1, 2021). NPs and PAs must complete 24 hours of training to be eligible for a waiver to prescribe and must be supervised by or work in collaboration with a qualifying physician if required by state law. The HHS Secretary has 18 months to issue updated regulations governing office based opioid addiction treatment to include NPs and PAs. Nurse practice laws and regulations are specific to each state. SBI S B I Screening Brief Intervention 5

6 So What is SBI? Screening Quickly assess the severity of substance use and identify the appropriate level of treatment. Brief Intervention Increase insight and awareness of substance use; motivation toward behavioral change. Step #1: Screening Checking In Prescreening SBIRT Tennessee,

7 Step #2 Administer Appropriate Test AUDIT DAST ASSIST AUDIT Alcohol Use Disorders Identification Test Ten questions Self administered or through an interview Addresses recent alcohol use, alcohol dependence symptoms, and alcohol related problems Developed by World Health Organization (WHO) DAST 10 Drug Abuse Screening Test Shortened version of DAST 28, containing 10 items Self administered or through an interview Developed by Addiction Research Foundation, now the Center for Addiction and Mental Health Yields a quantitative index of problems related to drug misuse 7

8 ASSIST Alcohol Smoking and Substance Involvement Screening Test 8 Questions about Substance Use Test can be completed by most in 10 minutes Result score card Feedback to patient Used in Brief Intervention WHO ASSIST Working Group (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction, 97 (9): Review Step #3: Brief Interventions Brief Intervention s 4 steps Raise the Subject Provide Feedback Enhance motivation Negotiate and Advise 8

9 Examples of Brief Interventions Adapted from Dunn, C, Fields, C. SBI Training for Trauma Care Providers. Substance Abuse and Mental Health Services Administration, CSAT. George Washington University, June 15, F Feedback (1 2 Minutes) Range Audit (0 40) DAST (0 10) Results Risk High Risk Reaction Patient s Thoughts What do you make of that? Adapted from Dunn, C, Fields, C. SBI Training for Trauma Care Providers. Substance Abuse and Mental Health Services Administration, CSAT. George Washington University, June 15, L Listen and Elicit (1 5 minutes) Explore Pros and Cons of drinking or use of illicit drugs Summarize both sides. Ask about importance. On a scale of 1 10, how important is it to you to change? Why did you give it that number and not a lower number? What would it take to raise that number? Ask about confidence. On a scale of 1 10, how confident are you that you can change successfully? Why did you give it that number and not a lower number? What would it take to raise that number? Adapted from Dunn, C, Fields, C. SBI Training for Trauma Care Providers. Substance Abuse and Mental Health Services Administration, CSAT. George Washington University, June 15,

10 O Options Goal Setting (1 5 minutes) Ask key questions about what they want to change What is their goal. Where does this leave you? Do you want to quit? Cut down? Make no change? If appropriate, ask about the plan. How will you do that? If you wanted to how would you? Who will help you? What might get in the way? Adapted from Dunn, C, Fields, C. SBI Training for Trauma Care Providers. Substance Abuse and Mental Health Services Administration, CSAT. George Washington University, June 15, S.E.W. Close on Good Terms (1 minute) Summarize patient s statements in favor of change Emphasize their strengths What agreement was reached Adapted from Dunn, C, Fields, C. SBI Training for Trauma Care Providers. Substance Abuse and Mental Health Services Administration, CSAT. George Washington University, June 15, SBI Aims to Identify and treat those at low to moderate risk for Substance Use Disorder Commercial Medicare Medicaid Screening & Brief Intervention 15 to 30 Minutes CPT G0396 H0049 Screening & Brief Intervention >30 Minutes CPT G0397 H0050 It s Billable 10

11 State Resources Tennessee REDLINE: Recovery Support Services: health/article/recovery Support Services Pregnant Women with SUD: health/article/treatment for pregnant women abusing substances Adult Substance Abuse Treatment: health/article/adult substance abuse treatment Crisis Detoxification: health/article/crisis Detoxification 11

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