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Implementing HB 2976. Steps for clinics to take to prepare to implement the law June 7, 2011. Disclosures. Mary Catlin has no financial disclosures that would constitute a conflict of interest There will be no unannounced discussion of off label use of FDA approved drugs or devices. - PowerPoint PPT Presentation
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Implementing HB 2976
Steps for clinics to take to prepare to implement the law
June 7, 2011
UW Project ROAM 1
Disclosures
• Mary Catlin has no financial disclosures that would constitute a conflict of interest
• There will be no unannounced discussion of off label use of FDA approved drugs or devices
UW Project ROAM 2
Objective of the legislation is to reduce suffering and to save lives
• Review what the legislation asks of you• Propose steps your facility can take to
implement the law
UW Project ROAM 3
ESHB 2876, rules CR-103P
• http://www.doh.wa.gov/hsqa/Professions/PainManagement/meetings.htm - site to access rules from all five boards of health
UW Project ROAM 4
Medical Preamble: “don’t worry be happy”
– “These rules..are not inflexible rules or rigid practice requirements and are not intended…to establish a legal standard of care outside of the context of the medial quality assurance jurisdiction.” “ …A reasonable course of action”
– A practitioner who differs from the rules should document justifications
UW Project ROAM 5
Implementing the Rules implies
• Continuing Education• Determining if your practitioners or site are
pain management specialists/clinic • A system for identifying and tracking patients• Forms and tools • Documentation template• A way to seek consultations
UW Project ROAM 6
Three levels of continuing education recommendations for
• Prescribers of long acting opioids• Providers exempt from consultation• Persons serving as pain management
consultants
UW Project ROAM 7
Continuing Education for Prescribers Note: “should”
WHO WHAT WHEN
PhysiciansWAC 248-919-858
4 hours CE on long acting opioids or methadone
Once in a lifetime
Osteopaths 4 hours CE on long acting opioids or methadone
Once in a lifetime
Nurse Practitioners 4 hours CE on long acting opioids or methadone
Once in a lifetime
Physician AssistantsWAC 248-918-808
4 hours CE on long acting opioids or methadone
Once in a lifetime
Dentists 4 hours CE on long acting opioids or methadone
Once in a lifetime
UW Project ROAM 8
Continuing Education to be Exempt from Consultation (Accredited CE)
WHO WHAT WHEN
PhysiciansWAC 248-919-858
12 hours CE with 2 hours on long acting opioids or methadone (Category 1)
Within 2 years
Osteopaths 12 hours CE with 2 hours on long acting opioids or methadone
Within 3 years
Nurse Practitioners 12 hours CE with 2 hours on long acting opioids or methadone
Within 2 years
Physician AssistantsWAC 248-918-812
12 hours CE with 2 hours on long acting opioids or methadone and the sponsoring MD has CE
Within 2 years
Dentists 12 hours CE 2 in opioids to include methadone
Within 2 years9
Continuing Education for Pain Management Specialists
WHO WHAT WHEN
Physicians 18 hours of CE in pain management
Within last 2 years
Nurse Practitioners 18 hours of CE in pain management
Within last 2 years
Osteopaths 18 hours of CE in pain management
Within last 3 years
Physician Assistants No definition as a specialistBut sponsoring MD can be
NA
Podiatrist 18 hours of CE in pain management
With in last 2 years
UW Project ROAM 10
Examples of opportunities for education
• PCSS-B training on buprenorphine. http://www.pcssb.org/ (Physicians Clinical Support System). SAMSHA funded
• American Academy of Pain Medicinehttp://www.painmed.org/CME/Calendar_MeetingsEvents.aspx (meetings
from multiple org for multiple professions)• American Academy of Family Practice Self study learning link serieshttp://www.aafp.org/online/en/home/cme/selfstudy/learninglink/pain1.html#Parsys66612• MQAC is preparing videos, webinars, fliers and extensive educational
material that will be available soon
• Project ECHO Telemedicine Clinics with UW specialists Contact Kent Unruh for more information ktunruh@uw.edu
UW Project ROAM 11
Project ECHO for Chronic Pain and Addiction: Discussion with UW Specialists and
Community Providers and free CME
Other requirements for specialists beyond CE refer to the rules
UW Project ROAM 13
• Board certified, eligible, sub-specialty, certificate OR
• Credentialed AND • Work in multi-disciplinary pain clinic or academic
research facility AND• Three years of experience AND • 30% of patients chronic pain• AND or OR varies by profession; PA not
specialists but NP can be
14UW Project ROAM
Forms to have on hand
• Pain agreement – include your fax/phone as last page so ED, and recipients can inform you easily
• Release of information meets CRF 42 Part 2 plus HIPPA (examples on Project Roam website)
• Pain guidelines or clinical pathway (AMDG)• List of EDs, urgent care facilities and pharmacies,
acceptable pain specialists • Morphine equivalent dose calculator
UW Project ROAM 15
AMDG Guidelines
Include tools and morphine equivalent dose calculator
Computer will need excel software installed.
www.agencymeddirectors.wa.gov/
16UW Project ROAM
MED dose converter
AMDG on-line toolwww.agencymeddirectors.wa.gov
– Lingua franca for Rx history:• “Current MED is …
Opioids used are: ...”
- Modify EMR to include this
17UW Project ROAM
Forms to have on-hand cont.
• Taper protocols or resources– Opioids – Benzodiazepines
• Patient education sheets-Informed consent materials-How to safe guard medications-Photo ID needed to pick up medications-Copy of patient agreement
UW Project ROAM 18
Forms: Review visit template• “Review visit” note contents from the WAC
– Change in pain relief, physical and psychosocial function, quality of life using standardized tools (AMDG)
– Compliance with prescribed meds and the MED– (Practical Note: Urine tests)– Opioid Risk Tool and aberrant behaviors – Escalating doses– Decision to continue, taper, stop, or change meds– Diagnosis – Plan– Efforts to seek consultation or other therapies
Review visit – automatic scheduler
UW Project ROAM 19
http://www.cpain.com/20UW Project ROAM
Project ECHO Intake form with required elements
21UW Project ROAM
Pain Agreement
• Rules say use for high risk – simpler to use for all or define high risk? – One prescriber, one pharmacy– Agree to urine/serum testing– Take medications as prescribed, safe guard them– No early refills– Agree not to use alcohol or “other medically
unauthorized substance”– Violations may result in tapering, or dc of medication
UW Project ROAM 22
Authorizations to share information
• Agree to share AGREEMENT with ED, urgent care and pharmacies
• Agree that other practitioners should report violations
• Physician may notify authorities of illegal acts
UW Project ROAM 23
Sharing information
• Pharmacy Monitoring Program up by January. • Emergency Room EDIE spreading
UW Project ROAM 24
If you don’t have EDIE
• Need to have a way of easily informing providers that their patient has been seeking pain medication.
• Prescription Monitoring Program will help
UW Project ROAM 25
Consultation
• Suggested: pediatric visits, hx substance abuse, psych co-morbidities
• Mandatory consult when patients are on greater than 120 MED doses
UW Project ROAM 26
Exemption from Consultation
• Patient is being tapered• Acute pain in a person on chronic opioid therapy• Pain and function are stable, dose not escalating• You tried! Document reasonable attempt to get a
consultation and why they are on 120 MED or more.
• But you can call into Project ECHO every Wed and alternate Fridays for a free consult.
UW Project ROAM 27
Project Echo contact Kent Unruh ktunruh@uw.edu or mccatlin@uw.edu
• PI Dr. John Scott• Specialists include Dr. Joe Merrill, Addiction
Medicine Specialist, Pain Specialist Dr. David Tauben, Psychiatrists Dr. Christina Flores, Dr. Mark Sullivan and others
• Addiction focus every other Friday and pain central focus every Wednesday.
• Grant funded research project. Try it it’s free!
UW Project ROAM 28
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