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Coursework, Nursing

Week 2: State Specific Guideline

Week 2: State Specific Guideline

Preparing the Assignment

  1. The State Specific Guidelines for Prescribing Controlled Substances & Medical Devices assignment is worth 125 points and will be graded on the quality of required components as summarized in the directions and grading criteria/rubric.
  2. Follow the directions and the grading criteria located in the rubric closely. Any questions about this assignment may be posted under the Q & A Forum or emailed to your faculty.
  3. The document provided should be used and your answers provided within the table provided on this document Links to an external site..
  4. Sources/links should be obtained directly from the state’s regulatory organization(s).
  5. It is recommended that you keep a copy of this assignment to provide to potential employers or your Board of Nursing to demonstrate your knowledge of your state laws.

Requirements:

  1. Guidelines and recommendations for your state:
    • In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following:
      1. Provide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education.
      2. Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note: you may need to contact your state’s board of nursing, pharmacy, or medicine if you cannot locate it on your own).
      3. Some states have multiple organizations or initiatives (ex: Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group’s recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention.
      4. Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 13 points. 5 points for when opioids are appropriate, 5 points for a safe duration of use, and 3 points for a current edition APA formatted reference.)
  2. State specific laws on controlled substance prescribing for the nurse practitioner:

    • Research your state laws on advanced practice nurses’ authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following:
      1. Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state.
      2. Discuss the provisions of the law, rule, code, or statute with regard to the following:
        • Conditions or limits on prescribing schedule I-V controlled substances.
        • Requirements (if any) in documentation for treating acute and chronic pain.
        • Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance? If so, what are they?
  3. State Prescription Drug Monitoring Program (PDMP):
    • Research your state’s PDMP* and provide the following information:
      1. Name of the state’s program.
      2. Website for the state PMDP.
      3. Discuss the registration requirements and process.
      4. Discuss the standards and procedures for the access and review of database information.
  4. State specific laws on medical devices prescribing for the nurse practitioner:
    • Research your state laws on advanced practice nurses’ authority to prescribe medical devices. These are also called Durable Medical Equipment (DME). Based on research done on the state where you will practice clinically, include the following:
      1. Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe medical devices or DME in your state.
      2. Discuss the provisions of the law, rule, code, or statute regarding the following:
        • Conditions or limits on prescribing medical devices or DME.
        • Requirements (if any) in documentation needed to support order of medical devices or DME.

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Question 

 Week 2: State Specific Guideline

Student Name:  Type your name here                                                                              

State of Planned NP Clinical Practice:  Michigan

Complete the following table with information specific to the state where you plan to practice as a nurse practitioner. Please refer to the rubric in the course to identify how much each prompt is worth.  Most are worth 5 or 6 points with one question being worth 10 points.  The 10 point question is noted in the table.

  • Sources should be obtained directly from the state’s regulatory organization(s) and must be cited appropriately.
  • It is recommended that you keep a copy of this paper to provide to potential employers or your Board of Nursing in order to demonstrate your knowledge of your state laws.

    Week 2: State Specific Guideline

    Week 2: State Specific Guideline

Guidelines and recommendations for your state:

In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following:
Provide the name of your practicing state’s organization, group or task force that created guidelines or recommendations for pain management therapies and education. Organization, group, or task force name

University of Michigan Health System

 Where you found this information (weblink):

https://www.michigan.gov/-/media/Project/Websites/lara/healthsystemslicensing/Folder3/UM_Pain_guidelines.pdf?rev=84d1466f7c32425b89c8f76979f4fedd
Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note: you may need to contact your state’s board of nursing, pharmacy, or medicine if you cannot locate it on your own). Overview of your state’s guideline development with web address.

The guidelines for clinical care of chronic nonterminal pain and the prescription practices for controlled substances were developed by the University of Michigan Health Systems stakeholders (University of Michigan Health System n.d.). The guidelines development process, along with the stakeholders involved and funding are found on the University of Michigan Health Systems website: https://www.michigan.gov/-/media/Project/Websites/lara/healthsystemslicensing/Folder3/UM_Pain_guidelines.pdf?rev=84d1466f7c32425b89c8f76979f4fedd

 Locate federal guidelines and provide a link to federal guidelines you could use in practice as a NP

https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
Some states have multiple organizations or initiatives (ex: Ohio) in place to combat the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group’s recommendations or initiatives. If your state does not have another state-specific resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention. Provide a brief overview of the group’s recommendations or initiatives (provide link to where you found information).

The Michigan Board of Pharmacy also provides best practices for pain management and opioid use. It outlines the up-to-date treatment modalities that exist in managing chronic non-cancer pain, as well as best practices when handling controlled substances for treating pain. It gives guidelines on prescription refills, prescription reviews, and patient referrals when handling patients with chronic pain (Michigan Board of Pharmacy, n.d.).

 Provide a brief overview of the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention (provide link to where you found information).

The Centers for Disease Control outlines guidelines for prescribing opioid medications in the US. The guidelines address four thematic concerns surrounding chronic pain management. These are determining when to initiate opioids, selecting specific opioid medications to give to the patients, deciding the duration of opioid therapy, and assessing and addressing risks associated with opioid use (CDC, 2022). This information can be accessed through the link: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth 10 points. 4 points for when opioids are appropriate, 4 points for a safe duration of use, and 2 points for a current edition APA formatted reference.) Opioids maintain effectiveness in the management of pain (Jones & Mason, 2022). The use of opioids is appropriate when patients present with severe acute pain. In chronic care, opioids can also be used in their lowest effective dose to manage moderate to severe pain, when the pain fails to resolve with NSAIDs and other pain-relieving modalities, including adjuncts (Shetty et al., 2024).

The duration of use of opioids in pain management varies. For acute pain unrelated to trauma or surgery, opioid use should not exceed seven days (CDC, 2022).  For chronic pain, opioids can be used for the entire period in which the pain exists, in their lowest effective doses. Frequent follow-ups are necessitated to allow risk assessment (CDC, 2022).

To enhance safety during opioid prescribing, prescriptions should be limited to 28-day supplies and discontinued whenever there is a justification to discontinue the medications. Likewise, the selection of opioid medication prescribed should be in a stepwise manner. Long-acting opioid medications that are less potent should be selected ahead of the highly potent opioid medications (AAFP, 2019).
State specific laws on controlled substance prescribing for the nurse practitioner:

Research your state laws on advanced practice nurses’ authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following:

 
Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe controlled substances in your state.

 

 Link to where you found law, rule, code, or statute for your state.

https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-333-17211a#:~:text=(2)%20If%20an%20advanced%20practice,in%20connection%20with%20that%20prescription.

 What does the law, rule, code, or statute say?

According to the Michigan legal statutes on prescribing controlled substances, NPs registered to practice in the state may prescribe nonscheduled prescription medications. Per these statutes, prescribing controlled substances is an act delegated to physicians. NPs, in this regard, are required to prescribe controlled substances under the supervision of a physician. In this respect, they are required to record their name, along with the name and DEA registration details of the physician (Molina, 2022).
Discuss the provisions of the law, rule, code, or statute regarding the following:

 

 Conditions or limits on prescribing schedule I-V controlled substances.

As per the Michigan legislation, prescribing controlled substances is an act delegated to physicians. NPs are thus not allowed to prescribe controlled substances independently. They can, however, prescribe these medications in connection with physicians, and indicate their names, their connection with the physicians, and the physician’s details whenever they prescribe a controlled substance (Molina, 2022).

 Requirements (if any) in documentation for treating acute and chronic pain. If your state has no requirements for this, confirm with a link of where you found this information.

Requirements for managing acute and chronic pain are provided for by clinical practice guidelines applicable in the state and Michigan statutes. As per these provisions, acute pain should be clearly distinguished from chronic pain before management. Likewise, treatment for acute and chronic pain should be multidimensional, integrating pharmacological and non-pharmacological interventions. Opioid therapy is only recommended when the conditions support its use (Molina, 2022).

Website: https://www.chapmanlawgroup.com/michigan-aprn-controlled-substance-prescribing-authorit/
Are there specific requirements for advanced practice nurses to reference the state’s prescription drug monitoring database before prescribing a controlled substance?  Yes or No

No. NPs in Michigan are not allowed to independently prescribe controlled substances. The act of prescribing controlled substances is a preserve for physicians (Michigan Legislature, n.d.)

 If yes, what are they? If not, how would they be helpful?

NPs can prescribe controlled substances as delegates. In such circumstances, they are required to record the name of the physician and indicate their connection with the physician.
State Prescription Drug Monitoring Program (PDMP): Research your state’s PDMP* and provide the following information:
Name of the state’s program. Michigan Automated Prescription System (MAPS)

 
Website for the state PMDP. https://www.michigan.gov/lara/bureau-list/bpl/health/maps
Discuss the registration requirements and process. As per Michigan laws, prescribers and pharmacists are required to be registered for the MAPS program. The prescribers are required to provide their professional license, personal DEA, and the National Provider Identifier before being allowed to access the MAPS program. They can register for the program online through the Customer Connect website. They then receive a confirmation email along with the terms and conditions. They then are required to submit their request to the regulators for final review and approval. A confirmation email will then be sent to the provider (MAPS, n.d.).
Discuss the standards and procedures for the access and review of database information. The MAPS database information can be accessed through its websites. Only prescribers and pharmacists are allowed to access and review database information. Prescribers, in this respect, include NPs, physicians, dentists, physician assistants with prescriptive authority, psychologists with prescriptive authority, and interns and medical residents with prescriptive authority (MAPS, n.d.).
State specific laws on medical devices prescribing for the nurse practitioner:

Research your state laws on advanced practice nurses’ authority to prescribe medical devices.  These are also called Durable Medical Equipment (DME).  Based on research done on the state where you will practice clinically, include the following:

 
Identify the law, rule, code, or statute that describes the advanced practice nurse’s authority to prescribe medical devices or DME in your state.

 

 Link to where you found law, rule, code, or statute for your state regarding prescribing DME in your state. 

https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder3/Folder62/Folder2/Folder162/Folder1/Folder262/MSA_18-17.pdf?rev=947143f64b5d425b820cb356a3aa0a14

 What does the law, rule, code, or statute say regarding prescribing DME in your state?

NPs, physicians, and Clinical Nurse Specialists can prescribe DMEs to persons who need them after a face-to-face evaluation of the individuals. The evaluation must be specific and accompanied by a written order. The order must not be older than six months from the order date (State of Michigan n.d.).
Discuss the provisions of the law, rule, code, or statute regarding the following:

 

 Conditions or limits on prescribing medical devices or DME.

Prescription of DMEs is limited to NPs, physicians, and clinical nurse specialists licensed in the state.

 Requirements (if any) in documentation needed to support order of medical devices or DME.

Prescriptions of DMEs are limited to clinical nurse specialists, NPs, and physicians in Michigan. They are required to do a face-to-face evaluation before prescribing any DME. They are also required to append their signatures and indicate the reason for prescribing the DMEs. The evaluation and the written order should not be older than six months from the date of order.

References

AAFP. (2019, April 19). Opioid prescribing for chronic pain. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/opioid-prescribing.html#:~:text=Opioid%20treatment%20should%20be%20continued,and%20function%20that%20outweighs%20risk.

CDC. (2022, November 3). CDC Clinical Practice Guideline for prescribing opioids for pain – united states, 2022. Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm

Jones, K. F., & Mason, D. J. (2022). The false dichotomy of pain and opioid use disorder. JAMA Health Forum, 3(4). https://doi.org/10.1001/jamahealthforum.2022.1406

MAPS. (n.d.). Mi automated prescription system (MAPS). SOM – State of Michigan. https://www.michigan.gov/lara/bureau-list/bpl/health/maps

Michigan Board of Pharmacy. (n.d.). Michigan-board-of-pharmacy-guidelines-for-the-use-of- … State of Michigan. https://www.michigan.gov/lara/-/media/Project/Websites/lara/bpl/Pharmacy/Boards-and-FAQs/Michigan-Board-of-Pharmacy-Guidelines-for-the-Use-of-Controlled-Substances-for-the-Treatment-of-Pain.pdf?rev=f9e426237a944ba0aeb0599a95962ab9&hash=1DBD3E902AE05E44FA3ACA144C8FB873

Michigan Legislature. (n.d.). Michigan legislature. MCL – Section 333.17211a – Michigan Legislature. https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-333-17211a#:~:text=(2)%20If%20an%20advanced%20practice,in%20connection%20with%20that%20prescription.

Molina, E. (2022, October 27). Michigan Aprn Controlled Substance Prescribing Authority. Chapman Law Group. https://www.chapmanlawgroup.com/michigan-aprn-controlled-substance-prescribing-authorit/

Shetty, A., Delanerolle, G., Cavalini, H., Deng, C., Yang, X., Boyd, A., Fernandez, T., Phiri, P., Bhaskar, A., & Shi, J. Q. (2024). A systematic review and network meta-analysis of pharmaceutical interventions used to manage chronic pain. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-023-49761-3

State of Michigan. (n.d.). MSA 18-17 distribution: Durable Medical Equipment … https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder3/Folder62/Folder2/Folder162/Folder1/Folder262/MSA_18-17.pdf?rev=947143f64b5d425b820cb356a3aa0a14

University of Michigan Health System. (n.d.). Managing chronic non-terminal pain. State of Michigan. https://www.michigan.gov/-/media/Project/Websites/lara/healthsystemslicensing/Folder3/UM_Pain_guidelines.pdf?rev=84d1466f7c32425b89c8f76979f4fedd