Description
The purpose of this assignment is to apply opiate prescribing guidelines in individual nursing practice. You are required to interview a pharmacist to complete Part Three of this paper. Write a 1,500-2,000-word paper that addresses the following:
Part One
Using the “2018 Arizona Opioid Prescribing Guidelines” in the topic Resources, describe how you would incorporate the prescription guidelines into your practice when caring for patients, communities, and populations. In your description provide a patient scenario for the following:
Summary Guidelines for the treatment of acute pain versus chronic pain
Elaborated Guidelines for the treatment of acute pain and chronic pain
Part Two
Review the “How to Implement These Guidelines Into Clinical Flow” section of the “2018 Arizona Opioid Prescribing Guidelines” in the topic Resources. Describe how you would implement the guidelines into your clinical practice, and provide a patient scenario that addresses the following:
Implement these guidelines into clinical flow.
Manage an “inherited patient” on opioid therapy.
Evaluate patients for opioid disorder.
Connect patients with medication-assisted treatment.
Approach an opioid exit strategy.
Manage pain and opioids in special populations.
Connect with local and national resources.
Correct clinical misperceptions about opioids.
Part Three
Interview an outpatient pharmacist. If possible, shadow the pharmacist. Discuss the following in your interview:
What key elements must be included in a prescription for scheduled medications
Answer : Prescriptions for scheduled medications, classified by their potential for abuse and dependence, require specific elements for safe and legal dispensing (DEA, 2023). These key elements include: (1) patient information (full name, address, date of birth), (2) prescriber information (name, DEA registration number, address, signature), (3) drug information (name, strength, dosage form, quantity), (4) clear directions for use (dosage, frequency, duration), and (5) refill information (number of allowed refills, if applicable). Additionally, some states mandate specific elements like diagnosis code or “no substitution” authorization (Mass.gov, 2013). Adherence to these standardized elements ensures proper medication use, reduces the risk of errors and diversion, and complies with relevant regulations (ISMP, 2023).References:DEA. (2023, January 17). Drug scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling ISMP. (2023). Key elements of medication use. Retrieved from https://www.ismp.org/key-elements-medication-use Mass.gov. (2013, July 1). Required elements of a written prescription. Retrieved from https://www.mass.gov/info-details/elements-of-a-written-prescription
Do you treat Scheduled II in the manner as Scheduled III-V? What is the difference between Scheduled II-V drugs?
What are the main issues you see with problematic opioid prescriptions that could have been prevented by the prescriber? What issues do you find yourself calling the provider for?
Answers: Problematic opioid prescriptions, defined as those contributing to misuse, addiction, or overdose, raise concerns about prescriber practices (Manchikanti et al., 2018). Key issues include: 1) Overprescribing: Initiating or continuing opioids without proper justification or exceeding recommended durations and dosages (Dowell et al., 2016). 2) Inadequate screening and assessment: Failing to assess risk factors for addiction, prior substance use, or mental health conditions (Dowell et al., 2016). 3) Lack of informed consent: Not discussing risks and benefits of opioid therapy with patients and failing to collaborate on treatment plans (CDC, 2020). 4) Concomitant prescribing of benzodiazepines: Increasing overdose risk when combined with opioids (Dowell et al., 2016). 5) Limited monitoring: Infrequent follow-up appointments, inadequate use of prescription drug monitoring programs (PDMPs), and failing to address signs of misuse (CDC, 2020). These issues highlight the need for improved prescriber education, adherence to evidence-based guidelines, and implementation of comprehensive pain management strategies to prevent opioid-related harm (Dowell et al., 2016; Manchikanti et al., 2018).ReferencesCenters for Disease Control and Prevention (CDC). (2020). CDC guideline for prescribing opioids for chronic pain – United States, 2020. MMWR. Recommendations and Reports, 69(4), 1-47. doi:10.15581/mmwr.rr69.04Dowell, D. C., Haegerich, T. M., Chou, R., Mather, L. E., Phillips, J. C., & Catlin, A. (2016). CDC guideline for prescribing opioids for chronic pain – United States, 2016. Journal of the American Medical Association, 315(12), 1249-1262. doi:10.1001/jama.2016.0360Manchikanti, L., Helmchen, C., & Kaye, A. D. (2018). Misuse of prescription opioids in chronic pain: Contribution of healthcare providers. Pain Physician, 21(2), 5-20. doi:10.1177/1554827017733160
What are the barriers or issues that would prevent a patient from receiving their opioid prescription
Answer Several barriers can impede a patient’s access to an opioid prescription, encompassing factors related to both the healthcare system and the patient themselves. On the provider side, concerns about addiction and potential misuse can lead to stricter prescribing practices, including reluctance to prescribe, lower dosages, and shorter durations (Dowell et al., 2016). Additionally, inadequate training on pain management and opioid use disorder (OUD) can hinder effective assessment and treatment decisions (Terman et al., 2017). For patients, stigma surrounding both pain and OUD can deter them from seeking care or disclosing their full medical history (Earnshaw et al., 2016). Furthermore, logistical challenges like lack of insurance, transportation difficulties, or inconvenient clinic hours can pose significant obstacles to accessing necessary prescriptions (Bailey et al., 2018). These complex and interconnected barriers highlight the need for multifaceted interventions to ensure equitable and appropriate access to pain management for all patients.References:
Bailey, J. E., Bohnert, A. S., & Dunn, J. W. (2018). Addressing social determinants of health to improve pain management: A review of the literature. Pain Medicine, 19(3), 401-411.
Dowell, D. C., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(12), 1249-1262.
Earnshaw, V. A., Wickramasinghe, N., & Mackey, S. (2016). Stigma and pain: A review of the literature. Pain Medicine, 17(1), 1-17.
Terman, W. M., & Kleber, H. D. (2017). The opioid crisis: A public health emergency with diverse origins. Jama, 317(16), 1639-1640.
In your opinion, how would we improve the opioid prescription process between the provider, pharmacy, and patient?
How does a pharmacist incorporate a prescription monitoring program (PMP) in their daily practicePharmacists play a crucial role in utilizing prescription drug monitoring programs (PDMPs) within their daily practice. This integration often involves (1) querying the PDMP for each patient receiving controlled substances, reviewing the report for potential red flags like doctor shopping or high-risk medication combinations (CDC, 2023). (2) Pharmacists then use this information to engage in patient counseling, discussing discrepancies, potential risks, and adherence concerns (SAMHSA, 2016). (3) Additionally, pharmacists report dispensed controlled substances to the PDMP, contributing to the program’s effectiveness and providing valuable data for future monitoring efforts (CDC, 2023). By seamlessly incorporating these steps, pharmacists leverage PDMPs to enhance patient safety, identify potential misuse, and contribute to broader public health initiatives in curbing prescription drug abuse.References:
Centers for Disease Control and Prevention. (2023, December 13). Prescription drug monitoring programs (PDMPs). Retrieved from https://www.cdc.gov/drugoverdose/pdmp/index.html
Substance Abuse and Mental Health Services Administration. (2016, June). In brief, prescription drug monitoring programs: A guide for healthcare providers. Retrieved from https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4997.pdf
Describe the components of the PMP including milligram morphine equivalent (MME).
You are required to cite three to five sources related to interprofessional collaboration to complete this assignment. Sources must be published within the past 5 years and appropriate for the assignment criteria and nursing content.
Prepare this paper according to the guidelines found in the APA Style Guide, located in the Student Success Center.
