Indiana Administrative Code › Title 848 - INDIANA STATE BOARD OF NURSING › Article 5 - PRESCRIPTIVE AUTHORITY FOR ADVANCED PRACTICE NURSING › Rule 4 - Opioid Prescribing Requirements › Section 4-5 - Advanced practice nurse with prescriptive authority discussion with patient; treatment agreement

Current through July 10, 2024
Authority: IC
				  25-22.5-13-3; IC
				  25-23-1-7
Affected: IC
				  25-1-9; IC 25-23
Sec. 5.
The advanced practice nurse with prescriptive authority shall
				  discuss with the patient the potential risks and benefits of opioid treatment
				  for chronic pain, as well as expectations related to prescription requests and
				  proper medication use. In doing so, the advanced practice nurse with
				  prescriptive authority shall do the following:
(1) Where alternative modalities to opioids
				for managing pain exist for a patient, discuss them with the patient.
(2) Provide a simple and clear explanation to
				help patients understand the key elements of their treatment plans.
(3) Counsel women between fourteen (14) and
				fifty-five (55) years of age with child bearing potential about the risks to
				the fetus when the mother has been taking opioids while pregnant. Such
				described risks shall include fetal opioid dependency and neonatal abstinence
				syndrome (NAS).
(4) Discuss with
				the patient risks of dependency and addiction.
(5) Discuss with the patient safe storage
				practices for prescribed opioids.
(6) Provide a written warning to the patient
				disclosing the risks associated with taking extended release medications that
				are not in an abuse deterrent form, if the advanced practice nurse with
				prescriptive authority prescribes for the patient a hydrocodone-only extended
				release medication that is not in an abuse deterrent form.
(7) Discuss with the patient the risks and
				benefits of using an abuse deterrent formulation, as opposed to a non-abuse
				deterrent formulation, if such a formulation exists for the opioid product the
				advanced practice nurse with prescriptive authority is prescribing to the
				patient.
(8) Together with the
				patient, review and sign a "Treatment Agreement", which shall include at least
				the following:
(A) The goals of the
				treatment.
(B) The patient's
				consent to drug monitoring testing in circumstances where the advanced practice
				nurse with prescriptive authority determines that drug monitoring testing is
				medically necessary.
(C) The
				advanced practice nurse with prescriptive authority's prescribing policies,
				which must include at least a:
(i) requirement
				that the patient take the medication as prescribed; and
(ii) prohibition of sharing medication with
				other individuals.
(D) A
				requirement that the patient inform the advanced practice nurse with
				prescriptive authority:
(i) about any other
				controlled substances prescribed or taken by the patient; and
(ii) if the patient drinks alcohol while
				taking opioids.
(E) The
				granting of permission to the advanced practice nurse with prescriptive
				authority to conduct random pill counts.
(F) Reasons the opioid therapy may be changed
				or discontinued by the advanced practice nurse with prescriptive authority.
A copy of the treatment agreement shall be retained in the
				  patient's chart.