Chronic Pain Management in Restricted Practice – Case of a 54-Year-Old Female
Concerns, Alternatives, Screening to Be Applied, and Own Ethical Standards
The major concern about the patient’s current regimen is drug abuse and addiction, especially for the pain medications. Refilling the drugs for six months may be a result of abuse and addiction, and therefore, the person selling the medication may lose the license due to selling controlled drugs. The best alternative is for the patient to sign a pain contract or an agreement to manage her pain. By signing the pain management contract, there will be evidence of tracking the drugs. The other alternative is to count the pills each time the patient is given. An exact number of pills for a particular day, as prescribed, should be counted and recorded before being given to the patient. Counting and recording will help reduce abuse and addiction concerns. There are other screenings that may be applied in this case to the patient. Random drug test screens should be done to ensure the patient is not abusing or misusing her drugs, where the amount of drugs in the body system is measured. In terms of ethical standards, in this case, I might consider interprofessional team collaboration. Interprofessional collaboration helps in passing the patient information from one professional to another, which prevents drug addiction and abuse. The professionals should link with each other and confirm the prescriptions and management before the patient is given the drugs.
Pain Contract for the Patient
The best pain contract for the patient is the pain medication agreement and consent form. Patient agreement forms can be used by patients for long-term treatment. Link; https://www.drugabuse.gov/sites/default/files/SamplePatientAgreementForms.pdf
Steps to Ensure Safe Prescription
I would take eight steps to ensure a safe prescription. The first step would be to ensure that the patient’s condition is well-defined and assessed. The second would be to identify the medical management goal. In the third step, I would have to choose the right treatment drug, and in the fourth step, commence the drug chosen with the correct information (Philpot et al., 2017). The fifth step would involve providing the patient with instructions and all necessary information on the drug. The sixth step will be to make a follow-up to evaluate the treatment. The costs associated with the treatment will be considered in the seventh step. The last step will be to reduce medical errors associated with prescriptions. The registry used in this case is the CURES (Controlled Substance Utilization Review and Evaluation System) and the Controlled Substance Prescriptions.
The Laws Surrounding Refills and the Amounts Allowed to Dispense With the Schedule II and III Medications in the State of CA
The laws concerning refills and dispense amounts are contained in Section 11164 of the Health and Safety Code. The laws under this section require prescribers to date the prescription to be dated and signed in ink (Bettencourt & Gopinath, 2019). The prescription should also have the name, phone number, and address of the prescriber. The name of the user should appear together with the information on refilling and the instructions for using the drugs.
Medication to Call, Write a Script or Electronic Order
The patient is on Losartan, Gabapentin, Atorvastatin, Diazepam, and Norco. All these drugs are crucial, and therefore, they will all require a prescription script or form in order. The elements required on the form include the name of the drug, the name of the patient, the address information, the date, the name of the professional prescribing, the DEA number of the prescriber, and the address. Other important information includes the prescriber’s signature, the number of refills, instructions for use, the amount prescribed, the strength of the drug, and the formulation of the drug.
Making a Report of Scheduled Prescription
In this case, the pharmacists displayed the information on Schedule II-IV restricted drugs before being supplied. The information can be found in the CURES. All the information concerning the prescription of a drug, such as the patient’s name, dosage, and prescriber details, should be entered into the system. This provides clear information about the drugs prescribed to the patient.
Standardized procedure or protocol for furnishing schedule II and III controlled substances with a patient-specific approach (protocol): Literature; https://www.mbc.ca.gov/Download/Documents/laws-guide.pdf
References
Bettencourt, M., & Gopinath, B. (2019). Medical Board of California. California Regulatory Law Reporter, 24(1), 49-71.
Philpot, L. M., Ramar, P., Elrashidi, M. Y., Mwangi, R., North, F., & Ebbert, J. O. (2017). Controlled substance agreements for opioids in a primary care practice. Journal of pharmaceutical policy and practice, 10(1), 1-7.
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Question 
Chronic Pain Management in Restricted Practice – Case of a 54-Year-Old Female
Discussion Prompt
You are a new FNP in a restricted state, and you have your DEA license and state furnishing for schedule II-V controlled substances. You are working at a busy family practice group, and you have a patient, ML, who is establishing care for the first time with your practice, and comes to you with the following scenario (ATTACHED):
Week 2 Pharmacology Discussion
In 600 or fewer words, but a minimum of 250, please describe your approach with this patient. In your paragraphs, include the following:
- What concerns do you have about her current regimen, and what alternatives will you discuss and offer? What other screenings might you apply? What are your own ethical standards in this case that you might consider in addition to legal standards?
- Provide a sample of an appropriate pain contract that would suit this patient and address her specific safety concerns (cite it and attach the actual contract you found – you do not have to make your own – there are plenty online)
- Include your steps to ensure safe prescribing. Include the registry you will search prior to any prescribing; name the CA registry and if you are in a different state, you should name that registry also.
- If you were to keep her current list, what are the laws surrounding refills and the amounts you are allowed to dispense with the schedule II and III medications in the state of CA? In your own state?
- Which medications on her list may you call into the pharmacy and which would you need a written script or electronic order? What are some elements required to include on the prescription form (paper or electronic signature) for the scheduled medications?
- After you prescribe, how, when, and where would you (or your staff) go about making a report of your scheduled prescription in the state registry so that other prescribers and pharmacies could be aware?
- In restricted states, APRN prescribers must follow a standardized procedure or protocol for furnishing schedule II and III controlled substances with a patient-specific approach. Please outline the minimum required components of a protocol. You may outline this in bullet form. Alternatively, you may find an appropriate protocol, clinical guideline, or standardized procedure from a literature search and attach it in lieu of outlining your own protocol.
Expectations
- Length: A minimum of 250 words, max of 600, not including references or attachments
- Citations: At least two high-level scholarly references in APA from within the last 5 years