Current through Register Vol. 35, No. 18, September 24, 2024
The following regulations shall be used by the board to
determine whether an optometrist's prescriptive practices are consistent with
the appropriate treatment of pain.
A.
The treatment of pain with drugs or controlled substances is a legitimate
optometric practice when accomplished in the usual course of professional
practice. It does not preclude treatment of patients with addiction, physical
dependence or tolerance, who have legitimate pain. However, such patients do
require very close monitoring and precise documentation.
B. The prescribing, ordering, administering
or dispensing of controlled substances to meet the individual needs of the
patient for management of chronic pain is appropriate if prescribed, ordered,
administered or dispensed in compliance with the following:
(1) An optometrist shall complete an
evaluation. The medical history shall include any previous history of
significant pain, past history of alternate treatments for pain, potential for
substance abuse, coexisting disease or medical conditions, and the presence of
a medical indication for or contra-indication against the use of controlled
substance.
(2) An optometrist shall
be familiar with and employ screening tools as appropriate, as well as the
spectrum of available modalities, in the evaluation and management of pain. The
optometrist shall consider an integrative approach to pain
management.
(3) A written treatment
plan shall be developed and tailored to the individual needs of the patient,
taking age, gender, culture, and ethnicity into consideration, with stated
objectives by which treatment can be evaluated, e.g. by degree of pain relief,
improved physical and psychological function, or other accepted measure. Such a
plan shall include a statement of the need for further testing, consultation,
referral or use of other treatment modalities.
(4) The optometrist shall discuss the risks
and benefits of using controlled substances with the patient, his surrogate or
guardian, and shall document this discussion in the record.
(5) Complete and accurate records of care
provided and drugs or controlled substances prescribed shall be maintained.
When controlled substances are prescribed, the name of the drug, quantity,
prescribed dosage and number of refills authorized shall be recorded.
Prescriptions for controlled substances shall include indications for
use.
(6) The management of patients
needing chronic pain control requires monitoring by the optometrist. The
optometrist shall periodically review the course of treatment for chronic pain,
the patient's state of health, and any new information about the etiology of
the chronic pain at least every six months. Chronic pain patients shall receive
all chronic pain management prescriptions from one optometrist and one pharmacy
whenever possible.
(7) In addition,
an optometrist shall consult, when indicated by the patient's condition, with
health care professionals who are experienced in the area of chronic pain
control; such professionals need not be those who specialize in pain
control.
(8) If, in an
optometrist's opinion, a patient is seeking pain medication for reasons that
are not medically justified, the optometrist is not required to prescribe
controlled substances for the patient.
C. The board will evaluate the quality of
care on the following basis: appropriate diagnosis and evaluation; appropriate
indication for the treatment prescribed; documented change or persistence of
the recognized indication; and, follow-up evaluation with appropriate
continuity of care. The board will judge the validity of prescribing based on
the optometrist's treatment of the patient and on available documentation,
rather than on the quantity and chronicity of prescribing. The goal is to
control the patient's pain for its duration while effectively addressing other
aspects of the patient's functioning, including physical, psychological,
social, and work-related factors.
D. The board will review both
over-prescription and under-prescription of pain medications using the same
standard of patient protection.
E.
An optometrist who appropriately prescribes controlled substances and who
follows this section would be considered to be in compliance with this rule and
not be subject to discipline by the board, unless there is some violation of
the Optometry Act or board rules.
