Washington Administrative Code › Title 246 - Health, Department of › PROFESSIONAL STANDARDS AND LICENSING › Chapter 246-840 - Practical and registered nursing › ADVANCED PRACTICE - PAIN MANAGEMENT › Section 246-840-465 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions apply in WAC
					 246-840-460
					 through 246-840-4990, unless the context clearly requires otherwise.
(1) "Aberrant behavior" means behavior that
				  indicates misuse, diversion, or substance use disorder. This includes, but is
				  not limited to, multiple early refills or renewals, or obtaining prescriptions
				  for the same or similar drugs from more than one practitioner or other health
				  care provider.
(2) "Acute pain"
				  means the normal, predicted physiological response to a noxious chemical,
				  thermal, or mechanical stimulus, and typically is associated with invasive
				  procedures, trauma, and disease.
Acute pain is considered to be six weeks or less in
					 duration.
(3) "Biological
				  specimen test" or "biological specimen testing" means testing of bodily fluids
				  or other biological samples including, but not limited to, urine or hair for
				  the presence of various drugs and metabolites.
(4) "Chronic pain" means a state in which
				  pain persists beyond the usual course of an acute disease or healing of an
				  injury, or that may or may not be associated with an acute or chronic
				  pathologic process, that causes continuous or intermittent pain more than
				  twelve weeks in duration, lasting months or years. Chronic pain includes pain
				  resulting from cancer or treatment in a patient who is two years post
				  completion of curative anti-cancer treatment with no current evidence of
				  disease.
(5) "Comorbidities" means
				  a preexisting or coexisting physical or psychiatric disease or
				  condition.
(6) "Episodic care"
				  means medical care provided by an advanced registered nurse practitioner other
				  than the designated primary care practitioner in the acute care setting, for
				  example, urgent care or emergency department.
(7) "High dose" means ninety milligram
				  morphine equivalent dose (MED), or more, per day.
(8) "High-risk" means a category of patient
				  at increased risk of morbidity or mortality, such as from comorbidities,
				  polypharmacy, history of substance use disorder or abuse, aberrant behavior,
				  high dose opioid prescription, or the use of any central nervous system
				  depressant.
(9) "Hospice" means a
				  model of care that focuses on relieving symptoms and supporting patients with a
				  life expectancy of six months or less.
(10) "Hospital" means any institution, place,
				  building, or agency licensed by the department under chapter 70.41 or 71.12 RCW
				  or designated as a state hospital under chapter 72.23 RCW, to provide
				  accommodations, facilities, and services over a continuous period of
				  twenty-four hours or more, for observation, diagnosis, or care of two or more
				  individuals not related to the operator who are suffering from illness, injury,
				  deformity, or abnormality, or from any other condition for which obstetrical,
				  medical, or surgical services would be appropriate for care or
				  diagnosis.
(11) "Inpatient" means a
				  person who has been admitted to a hospital for more than twenty-four
				  hours.
(12) "Medication assisted
				  treatment (MAT)" means the use of pharmacologic therapy, often in combination
				  with counseling and behavioral therapies, for the treatment of substance use
				  disorders.
(13) "Morphine
				  equivalent dose (MED)" means a conversion of various opioids to a morphine
				  equivalent dose by the use of accepted conversion tables or
				  calculators.
(14)
				  "Multidisciplinary pain clinic" means a facility that provides comprehensive
				  pain management and includes care provided by multiple available disciplines,
				  practitioners, or treatment modalities.
(15) "Nonoperative pain" means pain which
				  does not occur as a result of surgery.
(16) "Opioid analgesic" or "opioid" means a
				  drug that is either an opiate derived from the opium poppy, or opiate-like
				  semi-synthetic or synthetic drugs. Examples include morphine, codeine,
				  hydrocodone, oxycodone, fentanyl, meperidine, and methadone.
(17) "Palliative care" means care that
				  maintains or improves the quality of life of patients and their families facing
				  serious, advanced, or life-threatening illness. With palliative care,
				  particular attention is given to the prevention, assessment, and treatment of
				  pain and other symptoms, and to the provision of psychological, spiritual, and
				  emotional support.
(18) "Pain"
				  means an unpleasant sensory or emotional experience associated with actual or
				  potential tissue damage, or described in terms of such damage.
(19) "Pain management clinic" means a
				  publicly or privately owned facility for which a majority of patients are
				  receiving chronic pain treatment.
(20) "Perioperative pain" means acute pain
				  that occurs as the result of surgery.
(21) "Prescription monitoring program" or
				  "PMP" means the Washington state prescription monitoring program authorized
				  under chapter 70.225 RCW.
(22)
				  "Practitioner" means an advanced registered nurse practitioner licensed under
				  chapter 18.79 RCW, a dentist licensed under chapter 18.32 RCW, a physician
				  licensed under chapter 18.71 or 18.57 RCW, a physician assistant licensed under
				  chapter 18.71A or 18.57A RCW, or a podiatric physician licensed under chapter
				  18.22 RCW.
(23) "Risk assessment
				  tools" means validated tools or questionnaires appropriate for identifying a
				  patient's level of risk for substance use or misuse.
(24) "Subacute pain" means a continuation of
				  pain, of six to twelve weeks in duration.
(25) "Substance use disorder" means a
				  primary, chronic, neurobiological disease with genetic, psychosocial, and
				  environmental factors influencing its development and manifestations. Substance
				  use disorder is not the same as physical dependence or tolerance that are
				  normal physiological consequences of extended opioid therapy for pain. It is
				  characterized by behaviors that include, but are not limited to, impaired
				  control over drug use, craving, compulsive use, or continued use despite
				  harm.
Statutory Authority:
						RCW
						18.79.400. 11-10-064, § 246-840-465,
						filed 5/2/11, effective 7/1/11.