Washington Administrative Code
Title 246 - Health, Department of
PROFESSIONAL STANDARDS AND LICENSING
Chapter 246-853 - Osteopathic physicians and surgeons
OPIOID PRESCRIBING-CHRONIC PAIN MANAGEMENT
Section 246-853-715 - Patient evaluation and patient record
Universal Citation: WA Admin Code 246-853-715
Current through Register Vol. 24-18, September 15, 2024
(1) For the purposes of this section, "risk assessment tool" means professionally developed, clinically accepted questionnaires appropriate for identifying a patient's level of risk for substance abuse or misuse.
(2) The osteopathic physician shall evaluate and document the patient's health history and physical examination in the patient record prior to treating for chronic pain.
(a) History. The patient's health
history must include:
(i) The nature and
intensity of the pain;
(ii) The
effect of pain on physical and psychosocial function;
(iii) Current and past treatments for pain,
including medications and their efficacy;
(iv) Review of any significant
comorbidities;
(v) Any current or
historical substance use disorder;
(vi) Current medications and, as related to
treatment of pain, the efficacy of medications tried; and
(vii) Medication allergies.
(b) Evaluation. The patient
evaluation prior to opioid prescribing must include:
(i) Appropriate physical
examination;
(ii) Consideration of
the risks and benefits of chronic pain treatment for the patient;
(iii) Medications the patient is taking
including indication(s), date, type, dosage, quantity prescribed, and, as
related to treatment of the pain, efficacy of medications tried;
(iv) Review of the PMP to identify any
Schedule II-V medications or drugs of concern received by the patient in
accordance with the provisions of WAC 246-853-790;
(v) Any available diagnostic, therapeutic,
and laboratory results;
(vi) Use of
a risk assessment tool and assignment of the patient to a high-, moderate-, or
low-risk category. The osteopathic physician should use caution and shall
monitor a patient more frequently when prescribing opioid analgesics to a
patient identified as high-risk.
(vii) Any available consultations,
particularly as related to the patient's pain;
(viii) Pain related diagnosis, including
documentation of the presence of one or more recognized indications for the use
of pain medication;
(ix) Treatment
plan and objectives including:
(A)
Documentation of any medication prescribed;
(B) Biologic specimen testing ordered;
and
(C) Any labs or imaging
ordered;
(x) Written
agreements, also known as a "pain contract," for treatment between the patient
and the osteopathic physician; and
(xi) Patient counseling concerning risks,
benefits, and alternatives to chronic opioid therapy.
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