New Mexico Administrative Code › Title 16 - OCCUPATIONAL AND PROFESSIONAL LICENSING › Chapter 12 - NURSING AND HEALTH CARE RELATED PROVIDERS › Part 9 - MANAGEMENT OF CHRONIC PAIN WITH CONTROLLED SUBSTANCES › Section 16.12.9.8 - RULES

Current through Register Vol. 35, No. 13, July 16, 2024
The following rules shall be used by the board to determine
				  whether an advanced practice nurse's prescriptive practices are consistent with
				  the appropriate treatment of pain.
A.
				The treatment of pain with various medicines or controlled substances is a
				legitimate nursing practice when accomplished in the usual course of
				professional practice. It does not preclude treatment of patients with
				addiction, physical dependence or tolerance who have legitimate pain. However,
				such patients do require very close monitoring and precise
				documentation.
B. Pain management
				for patients should include a contractual agreement, the use of drug screens
				prior to treatment with opiates and during the course of treatment to identify
				actual drugs being consumed and to compare with patients self-reports. If
				concerns about misuse are identified, the patient will be referred for
				appropriate consultation, and scheduled for re-evaluation at appropriate time
				intervals.
C. The prescribing,
				ordering, administering or dispensing of controlled substances to meet the
				individual needs of the patient for management of chronic pain is appropriate
				if prescribed, ordered, administered or dispensed in compliance with the
				following.
(1) An advanced practice nurse
				shall complete a history and physical examination and include an evaluation of
				the patient's psychological and pain status. The medical history shall include
				any previous history of significant pain, past history of alternate treatments
				for pain, potential for substances abuse, coexisting disease or medical
				conditions, and the presence of a medical indication and supporting diagnostic
				documentation or contra-indication against the use of controlled
				substances.
(2) An advanced
				practice nurse shall be familiar with and employ screening tools, as well as
				the spectrum of available modalities for therapeutic purposes, in the
				evaluation and management of pain. They shall consider an integrative approach
				to pain management specialists including but not limited to an acupuncturist,
				chiropractor, doctor of oriental medicine, exercise physiologist, massage
				therapist, pharmacist, physical therapist, psychiatrist, psychologist or other
				advanced practice registered nurse.
(3) A written treatment plan shall be
				developed and tailored to the individual needs of the patient, taking age,
				gender, culture, and ethnicity into consideration, with stated objectives by
				which treatment can be evaluated, e.g. by degree of pain relief, improved
				physical and psychological function, or other accepted measure. Such a plan
				should include a statement of the need for further testing, consultation,
				referral or use of other treatment modalities.
(4) If the patient's pain relief plateaus on
				controlled substance analgesic(s), then the treatment plan should include an
				evaluation of continuing or tapering the controlled substance
				therapy.
(5) The practitioner shall
				provide education and discuss the risks and benefits of using controlled
				substances with the patient or surrogate or guardian, and shall document this
				in the record.
(6) Complete and
				accurate records of care provided and drugs prescribed shall be maintained.
				When controlled substances are prescribed, the name of the drug, quantity, and
				prescribed dosage should be recorded. Prescriptions for opioids shall include
				indications for use. For chronic non-cancer pain patients treated with
				controlled substance analgesic(s), the prescribing practitioner shall use a
				written agreement for treatment with the patient outlining patient
				responsibilities. As part of a written agreement, chronic non-cancer pain
				patients shall receive all chronic pain management prescriptions from one
				practitioner and one pharmacy whenever possible.
(7) The management of patients needing
				chronic pain control requires monitoring by the attending or the consulting
				practitioner. The practitioner shall periodically review the course of
				treatment for chronic non-cancer pain, the patient's state of health, and any
				new information about the etiology of the chronic non-cancer pain at least
				every three months. In addition, a practitioner should consult, when indicated
				by the patient's condition, with health care professionals who are experienced
				(by the length and type of their practice) in the area of chronic pain control;
				such professionals need not be those who specialize in pain control.
				Consultation should occur early in the course of long-term treatment, and at
				reasonable intervals during continued long-term treatment for assessment of
				benefit and need. Drug screening is expected and should be conducted when other
				factors suggest an elevated risk of misuse or diversion.
(8) If, in a practitioner's opinion, a
				patient is seeking pain medication for reasons that are not medically
				justified, the practitioner is not required to prescribe controlled substances
				for the patient.