Section 848IAC5-4-5. Advanced practice nurse with prescriptive authority discussion with patient; treatment agreement

   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.

(Indiana State Board of Nursing; 848 IAC 5-4-5; filed Aug 10, 2016, 1:52 p.m.: 20160907-IR-848150380FRA)