Description
Firstly, I would express empathy towards ML’s situation, understanding the challenges she faces in accessing healthcare. Given her complex history and the need for long-term management, I would aim for a patient-centered approach.
Some concern that I would address for this patient are use of Norco up to 4-5 times a day raises concerns about potential overuse, dependency, and side effects. I would discuss non-opioid alternatives and explore the possibility of reducing opioid reliance. Diazepam, especially when used up to TID, poses risks of sedation and dependence. I would discuss non-benzodiazepine options for pain and anxiety management. Given ML’s health conditions and medication use, addressing smoking and alcohol consumption is crucial. Both can interact with medications and exacerbate chronic conditions.
Alternative Medications and Screenings exploring alternatives such as physical therapy, non-opioid analgesics, and considering injections for localized pain. Cognitive-behavioral therapy, non-benzodiazepine anxiolytics, or counseling may be explored. Referral to smoking cessation programs and counseling services for alcohol reduction. Evaluate her medications against California’s Prescription Drug Monitoring Program (PDMP) to ensure accurate tracking of controlled substances. Apart from legal considerations, my ethical standards involve prioritizing patient safety, informed decision-making, and holistic care. I would respect her autonomy while emphasizing the potential risks associated with her current medication regimen.
I would use a pain contract template from a source such as the American Academy of Pain Medicine (AAPM). An example can be found https://painmed.org/about-the-american-academy-of-pain-medicine/ (AAPM, 2022).
Prescription Drug Monitoring Program (PDMP) Check utilize the California PDMP before prescribing controlled substances. Prescription Elements include patient name, medication name, strength, quantity, directions for use, and appropriate signatures for each prescription. Refill Laws in CA for Schedule III medications can be refilled up to five times within six months, and Schedule II medications cannot be refilled. This aligns with federal regulations (CDC, 2022). Electronic Prescriptions for Schedule II prescriptions require a physical prescription, while Schedule III medications can be transmitted electronically. Reporting to PDMP and submit information to the California PDMP promptly after prescribing, ensuring other healthcare providers are aware of the patient’s-controlled substance history.
As an APRN, I would use protocol Components such as patient evaluation thorough patient assessment, including medical history and risk assessment. Treatment Plan: Clearly defined treatment plan outlining non-opioid options, frequency of follow-up, and monitoring for side effects. Consultation Requirement: Establish a requirement for consultation with a collaborating physician, especially for Schedule II medications. Documentation: Maintain detailed records of patient visits, treatment rationale, and adherence to the protocol. This patient requires a collaborative, multidisciplinary approach to address her chronic pain, considering the legal and ethical aspects of prescribing controlled substances. Regular follow-ups and collaboration with other healthcare providers will be essential for comprehensive care.
Reference
American Academy of Pain Medicine. (2022). About the American Academy of Pain Medicine. Retrieved from https://painmed.org/about-the-american-academy-of-pain-medicine/
Centers for Disease Control and Prevention. (2022, January 10). Prescription Drug Monitoring Programs (PDMPs). Retrieved from https://www.cdc.gov/opioids/healthcare-professionals/pdmps.html
