Washington Administrative Code
Title 246 - Health, Department of
PROFESSIONAL STANDARDS AND LICENSING
Chapter 246-918 - Physician assistants Washington medical commission
OPIOID PRESCRIBING-SUBACUTE PAIN
Section 246-918-845 - Patient evaluation and patient record-Subacute pain
Universal Citation: WA Admin Code 246-918-845
Current through Register Vol. 24-18, September 15, 2024
The physician assistant shall comply with the requirements in this section when prescribing opioids for subacute pain.
(1) Prior to issuing an opioid prescription for subacute pain, the physician assistant shall assess the rationale for continuing opioid therapy:
(a) Conduct an
appropriate history and physical examination;
(b) Reevaluate the nature and intensity of
the pain;
(c) Conduct, or cause
their designee to conduct, a query of the PMP in accordance with the provisions
of WAC 246-918-935;
(d) Screen the
patient's level of risk for aberrant behavior and adverse events related to
opioid therapy;
(e) Obtain a
biological specimen test if the patient's functional status is deteriorating or
if pain is escalating; and
(f)
Screen or refer the patient for further consultation for psychosocial factors
if the patient's functional status is deteriorating or if pain is
escalating.
(2) The physician assistant treating a patient for subacute pain with opioids shall ensure that, at a minimum, the following is documented in the patient record:
(a) The presence of one or more recognized
diagnoses or indications for the use of opioid pain medication;
(b) The observed or reported effect on
function or pain control forming the basis to continue prescribing opioids
beyond the acute pain episode;
(c)
Pertinent concerns discovered in the PMP;
(d) An appropriate pain treatment plan
including the consideration of, or attempts to use, nonpharmacological
modalities and nonopioid therapy;
(e) The action plan for any aberrant
biological specimen testing results and the risk-benefit analysis if opioids
are to be continued;
(f) Results of
psychosocial screening or consultation;
(g) Results of screening for the patient's
level of risk for aberrant behavior and adverse events related to opioid
therapy, and mitigation strategies; and
(h) The risk-benefit analysis of any
combination of prescribed opioid and benzodiazepines or sedative-hypnotics, if
applicable.
(3) Follow-up visits for pain control must include objectives or metrics to be used to determine treatment success if opioids are to be continued. This includes, at a minimum:
(a) Change in pain level;
(b) Change in physical function;
(c) Change in psychosocial function;
and
(d) Additional indicated
diagnostic evaluations or other treatments.
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