NR565Week1
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NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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Student Name: Samantha Joy
State of Planned NP Clinical Practice: Indiana
Complete the following table with information specific to the state where you plan to practice as a nurse practitioner. Please refer to the rubric in the course to identify how much each prompt is worth. Most are worth 5 or 6 points with one question being worth 10 points. The 10 point question is noted in the table.
Sources should be obtained directly from the state's regulatory organization(s) and must be cited appropriately.
It is recommended that you keep a copy of this paper to provide to potential employers or your Board of Nursing in order to demonstrate your knowledge of your state laws.
Guidelines and recommendations for your state:
In response to the opioid epidemic, individual states have developed and adopted voluntary guidelines or recommendations for the
treatment of acute and chronic non-cancer pain. Based on research done on the state where you will practice clinically, include the following:
Provide the name of your practicing state's organization, group or task force that created guidelines or recommendations for pain management therapies and education.
Organization, group, or task force name Indiana State Medical Association (ISMA)
Indiana Hospital Association
Indiana State Department of Health
Indiana Guidelines for Opioid Prescribing
in the Emergency Department
Indiana Chronic Pain Management Prescribing Rule
U.S. Drug Enforcement Administration
National Center for Health Statistics
Where you found this information (weblink): Opioid Prescribing (ismanet.org)
Briefly describe an overview of its development and include a web address where this information can be found. If your state does not have guidelines, discuss a federal guideline. (Note: you Overview of your state’s guideline development with web address. ISMA provides evidence-based guidelines
to address opioid prescribing, non-opioid pain management, patient counseling and Locate federal guidelines and provide a link to federal guidelines you could use in practice as a NP
CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain | Guidelines |
NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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may need to contact your state's board of nursing, pharmacy, or medicine if you cannot locate it on your own).
education with patient-shareable materials, and pain control to optimize or improve recovery goals. ISMA provides information on surgical and acute care related to pain management interventions including safe medication practices, pediatric-specific guidelines, medication disposal guidelines, and medication addiction. Healthcare Professionals | Opioids | CDC
Some states have multiple organizations or initiatives (ex: Ohio) in place to combat
the opioid epidemic and advocate for safer opioid prescribing. Explore whether your state has other resources, groups or organizations where prescribers can reference best practices for pain management treatment. If applicable, provide a brief overview of the group's recommendations or initiatives. If your state does not have another state-specific
resource, discuss the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention.
Provide a brief
overview of the group's
recommendations or initiatives (provide link to where you found information).
Health: Overdose Prevention: Opioid Prescribing Guidelines
The Indiana Department of Health has several initiatives in place to combat the opioid epidemic. Documented education about addition, disposal, misuse, unlawful
delivery to others, and pregnancy effects. Documentation for patient-physician relationship which includes follow-up care and an INSPECT review for quantities exceeding three-day supply. Additional provisions included discussing acute pain prescribing quantities, overdose prescribing, and opioid abuse treatment
Provide a brief overview of the guidelines published by the American Pain Society OR Centers for Disease Control and Prevention (provide link to
where you found information).
Guidelines for Prescribing Opioids for Chronic Pain Factsheet (cdc.gov)
The CDC provides guidelines for many aspects of the management of pain, including when nonpharmacologic therapy vs. non-opioid vs. opioid therapy should be used, and how to select, maintain, and stop opioids. Education topics along the treatment path and how to
weigh the benefits versus risks of opioid therapy, as well as discussions to have with patients on this topic.
Discuss when the use of opioids is appropriate and for what duration should they be prescribed? Provide a reference for your response. (This question is worth
10 points. 4 points for when opioids are The use of opioids is appropriate for acute pain management, cancer pain, end-of-life care, and chronic non-cancer pain (Centers for Disease Control and Prevention [CDC], 2023).
The duration for prescribing opioids should be short-term 1-3 months for acute pain
NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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appropriate, 4 points for a safe duration of
use, and 2 points for a current edition APA
formatted reference.)
(Centers for Disease Control and Prevention [CDC], 2023). Chronic pain opioid prescribing duration >3 months needs to be reassessed to make sure the medication is working or not working, the patient is able to function, and if there are any side effects to the medication (Centers for Disease Control and Prevention [CDC], 2023). Patients need to be assessed for opioid misuse, overdose, and addition. The patient and the health care professional need to come to a decision on the opioid therapy duration and what they want to get out of taking the medication. Centers for Disease Control and Prevention. (2023, March 6). Cdc clinical practice guideline for prescribing opioids for pain — united states, 2022
. Retrieved September 12, 2023, from https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm
State specific laws on controlled substance prescribing for the nurse practitioner:
Research your state laws on advanced practice nurses' authority to prescribe controlled substances. Based on research done on the state where you will practice clinically, include the following:
Identify the law, rule, code, or statute that describes the advanced practice nurse's authority to prescribe controlled substances in your state.
Link to where you found law, rule, code, or statute for your state. Indiana Nurse Practice Act (2013)
What does the law, rule, code, or statute say?
The law defines APRN as any clinical nurse specialist, nurse midwife, and nurse practitioner. APRNs have the authority to prescribe schedule 2-5 controlled substances under a supervising physician, including the name, DEA number, license number, and signature of the supervising physician and prescribing APRN, and quantity may not exceed a 30-day supply. Discuss the provisions of the law, rule,
Conditions or limits on prescribing Requirements (if any) in
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NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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code, or statute regarding the following:
schedule I-V controlled substances.
APRNs in Indiana may prescribe schedule
II-V only under a supervising physician. Collaboration documentation between the physician and APRN must exist, and written authorization of delegation from the physician. In addition, APRNs are not
authorized to be delegated to prescribe greater than a 30-day supply of controlled substances. APRNs in Indiana need to have an Indiana Controlled Substances Registration. Schedule 1 drugs are not acceptable for use in medical care but can be used by researchers. documentation for treating acute and chronic pain. If your state has no requirements for this, confirm with a link of where you found this information. When treating any pain, an initial assessment, intervention (nonpharmacologic, non-opioid, or opioid), and evaluation should be documented in the patient's record, and should also include plan of care changes as well as physician communication related to treatment of acute and chronic pain. The requirement of pain documentation reflects the validity of the prescribed medication.
Health: Overdose Prevention: Opioid Prescribing Guidelines
Are there specific requirements for advanced practice nurses to reference the state's prescription drug monitoring database before prescribing a controlled substance? Yes or No
Yes, when the prescribing quantity exceeds a 3-day supply.
If yes, what are they? If not, how would
they be helpful?
Indiana’s Prescription Drug Monitoring Program (IPDMP) must be reviewed if prescribing greater than a 3 days’ supply of a schedule II-V controlled substance. State Prescription Drug Monitoring Program (PDMP): Research your state's PDMP* and provide the following information:
Name of the state's program.
Indiana's Prescription Drug Monitoring Program (INSPECT)
Website for the state PMDP.
Indiana Prescription Monitoring Program (usdoj.gov)
Discuss the registration requirements and
process.
Registration first includes an application consisting of email, password, role selection (healthcare professionalAPRN), professional details (DEA number, national provider ID, professional license number, healthcare specialty, personal information, DOB, SSN, phone number, and employer information. The applicant verifies the email address and is required to validate and upload supporting documentation. Once the account is approved the user can begin using INSPECT system.
NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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Indiana Prescription Monitoring Program (usdoj.gov)
Discuss the standards and procedures for
the access and review of database information.
It is the standard for prescribers to utilize the INSPECT for review at minimum when prescribing schedule II-V controlled substances in greater than a 3-day supply. The procedures for accessing and reviewing the information regarding a patient include first entering patient information, the prescription dates in question, selecting interconnected states, and finally viewing the patient report. When reviewing the database information multiple patients may meet the entered criteria, so careful selection is imperative. The reviewer may then see the total number of prescriptions (including which ones were filled and when), prescribers, and pharmacies that filled said prescriptions. Indiana Prescription Monitoring Program (usdoj.gov)
State specific laws on medical devices prescribing for the nurse practitioner:
Research your state laws on advanced practice nurses' authority to prescribe medical devices. These are also called Durable Medical Equipment (DME). Based on research done on the state where you will practice clinically, include the following:
Identify the law, rule, code, or statute that describes the advanced practice nurse's authority to prescribe medical devices or DME in your state.
Link to where you found law, rule, code, or statute for your state regarding
prescribing DME in your state. Durable and Home Medical Equipment and Supplies (in.gov)
What does the law, rule, code, or statute say regarding prescribing DME in your state?
In accordance with the Affordable Care Act, Indiana enforces several DME prescribing laws. Any equipment that requires a face-to-face visit for the initial prescription or alterations to the prescription must be prescribed by an Indiana Health Coverage Programs (IHCP)
physician, but the APRN can do the face-to-face visit. They IHCP physician will need to certify that the visit
was documented. A list of medical equipment is included in the Centers for Medicare and Medicaid Services manual and includes items such as hospital beds,
NR565 Week 2: State Specific Guidelines for Prescribing Controlled Substances & Medical Devices
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oxygen, nebulizers and related equipment,
CPAP, lifts, diabetes monitoring equipment, nerve stimulators, wheelchairs, and AEDs.
Discuss the provisions of the law, rule,
code, or statute regarding the following:
Conditions or limits on prescribing medical devices or DME.
APRNs (including CNS, CNM, and NP) can perform the face-to-face visit necessitating the need for the DME and the IHCP physician will write the prescription for the DME equipment.
Requirements (if any) in documentation needed to support order of medical devices or DME.
Documentation of a face-to-face visit was performed by an APRN or physician, but the physician has to certify the visit was done. The visit information with documentation for the need for DME must
remain in the patient's record, as well as any necessary accompanying paperwork such as prior authorization and documentation for the need for continued therapy with renewals.
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