Current through all regulations passed and filed through September 16, 2024
(A) Definitions; for purposes of this rule:
(1) "APRN" means a clinical nurse specialist,
certified nurse-midwife, or certified nurse practitioner who holds a current,
valid license as an advanced practice registered nurse issued by the
board.
(2) "Delegate" means an
authorized representative who is registered to obtain an OARRS report on behalf
of an APRN.
(3) "OARRS" means the
Ohio automated RX reporting system established and maintained according to
section 4729.75 of the Revised
Code.
(4) "OARRS report" means a
report of information related to a specified patient generated by the drug
database established maintained by the state board of pharmacy pursuant to
section 4729.75 of the Revised
Code.
(5) "Reported drugs" means
all drugs listed in rule 4729:8-2-01 of the Administrative Code that are
required to be reported to the drug database established and maintained
according to section 4729.75 of the Revised Code,
including controlled substance schedules II, III, IV and V.
(B) Standards of care: in addition
to the requirements set forth in rule
4723-9-08 and rule
4723-9-10 of the Administrative
Code, accepted and prevailing standards of care require that when prescribing
or personally furnishing a reported drug, an APRN shall taking into account the
potential for abuse of the reported drug, the possibility that the reported
drug may lead to dependence, the possibility the patient will obtain the
reported drug for a nontherapeutic use or distribute it to other persons, and
the potential existence of an illicit market for the reported drug. When
considering these circumstances in the course of determining whether to
prescribe or personally furnish a reported drug to a patient, the APRN shall
use sound clinical judgment and consider obtaining and reviewing an OARRS
report, consistent with the requirements of this rule.
(C) Red flags: an APRN shall obtain and
review an OARRS report when any of the following red flags pertain to the
patient:
(1) Selling prescription
drugs;
(2) Forging or altering a
prescription;
(3) Stealing or
borrowing reported drugs;
(4)
Increasing the dosage of reported drugs in amounts that exceed the prescribed
amount;
(5) Suffering an overdose,
intentional or nonintentional;
(6)
Having a drug screen result that is inconsistent with the treatment plan or
refusing to participate in a drug screen;
(7) Having been arrested, convicted, or
received diversion, or intervention in lieu of conviction for a drug-related
offense while under the APRN's care;
(8) Receiving reported drugs from multiple
prescribers, without clinical basis;
(9) Traveling with a group of other patients
to the APRN's office, where all or most of the patients request controlled
substances prescriptions;
(10)
Traveling an extended distance or from out of state to the APRN's
office;
(11) Having a family
member, friend, law enforcement officer or health care professional express
concern related to the patient's use of illegal or reported drugs;
(12) A known history of chemical abuse or
dependency;
(13) Appearing impaired
or overly sedated during an office visit or examination;
(14) Requesting reported drugs by specific
name, street name, color, or identifying marks;
(15) Frequently requesting early refills of
reported drugs;
(16) Frequently
losing prescriptions for reported drugs;
(17) A history of illegal drug use;
(18) Sharing reported drugs with another
person; or
(19) Recurring visits to
non-coordinated sites of care, such as emergency departments, urgent care
facilities, or walk-in clinics to obtain reported drugs.
(D) OARRS review; opioid analgesics and
benzodiazepines..
Except as provided in paragraph (G) of this rule, an APRN
shall:
(1) Obtain and review an OARRS
report before initially prescribing to a patient a reported drug that is an
opioid analgesic or benzodiazepine;
(2) Obtain and review an OARRS report when
prescribing opioid analgesics for the treatment of sub-acute and chronic pain
as set forth in rule
4723-9-10 of the Administrative
Code;
(3) If the patient continues
to receive opioid analgesics or benzodiazepines for more than ninety days after
the initial report is requested, the APRN shall obtain and review OARRS reports
for the patient at intervals not exceeding ninety days, determined according to
the date the initial request was made, and until the course of treatment has
ended; and
(4) In obtaining and
reviewing OARRS reports, comply with paragraph (F) of this rule.
(E) OARRS review; reported drugs
that are not opioid analgesics or benzodiazepines.
Except as provided in paragraph (G) of this rule, an APRN
shall:
(1) Obtain and review an OARRS
report following a course of treatment for a period of more than ninety days if
the treatment includes the prescribing or personally furnishing of reported
drugs that are not opioid analgesics or benzodiazepines;
(2) Obtain and review an OARRS report at
least annually thereafter until the course of treatment utilizing these
reported drugs has ended; and
(3)
In obtaining and reviewing OARRS reports, comply with paragraph (F) of this
rule.
(F) OARRS reports;
time period; adjoining state: for purposes of paragraphs (C), (D), and (E) of
this rule:
(1) OARRS reports may be requested
by the APRN's delegate but must be personally reviewed by the APRN;
(2) Receipt and assessment of the OARRS
report information, including consultation with the collaborating physician
that occurred based on the OARRS report information or as required by paragraph
(H) of this rule, shall be documented in the patient record;
(3) Initial reports requested shall cover at
least twelve months immediately preceding the date of the request;
(4) If the APRN practices in a county of this
state that adjoins another state, the APRN or the APRN's delegate shall also
request a report of any information available in the drug database that
pertains to prescriptions issued or drugs furnished to the patient in the state
adjoining the county; and
(5) If an
OARRS report regarding the patient is not available, the APRN shall document in
the patient's record the reason that the report is not available and any
efforts made in follow-up to obtain the requested information.
(G) OARRS report exceptions: an
APRN shall not be required to review and assess an OARRS report when
prescribing or personally furnishing a reported drug under the following
circumstances, unless the APRN believes or has reason to believe that the
patient may be abusing or diverting reported drugs;
(1) The reported drug is prescribed or
personally furnished to a hospice patient in a hospice care program as those
terms are defined in section
3712.01 of the Revised
Code;
(2) The reported drug is
prescribed or personally furnished to a patient who has been diagnosed with
terminal cancer or another terminal condition, as defined in section
2133.01 of the Revised
Code;
(3) The reported drug is
prescribed for administration in a hospital, nursing home, or residential care
facility;
(4) The reported drug is
prescribed or personally furnished in an amount indicated for a period not to
exceed seven days; or
(5) The
reported drug is prescribed for treatment of non-terminal cancer or another
condition associated with non-terminal cancer, except if prescribed for
sub-acute or chronic pain and an OARRS report review is required by rule
4723-9-10 of the Administrative
Code.
(H) Physician
consultation: an APRN who prescribes or personally furnishes a reported drug to
a patient following review of an OARRS report under paragraph (C), (D), or (E)
of this rule, and determines, based on the OARRS report or red flags described
in paragraph (C) of this rule that the patient may be abusing or diverting
reported drugs, shall first consult with a physician prior to
personally furnishing or prescribing a reported drug at the patient's next
visit.
(1) Consultation shall include and
result in:
(a) Review and documentation of
the reasons why the APRN believes or has reason to believe that the patient may
be abusing or diverting drugs;
(b)
Review and documentation of the patient's progress toward treatment objectives
over the course of treatment; and
(c) Review and documentation of the
functional status of the patient, including activities for daily living,
adverse effects, analgesia and aberrant behavior over the course of
treatment.
(2)
Consultation may include and result in:
(a)
Utilization of a patient treatment agreement that includes more frequent and
periodic review of OARRS reports, more frequent office visits, different
treatment options, drug screens, use of one pharmacy, use of one provider for
the prescription or personally furnishing of reported drugs, and consequences
for non-compliance with the terms of the agreement. The patient treatment
agreement shall be maintained as part of the patient record; and
(b) Consultation with or referral to a
substance use disorder specialist.
