WHITE WILSON MEDICAL CENTER, PA
CONTROLLED SUBSTANCE PROTOCOL
General Information:
1.This protocol covers any prescription written for the treatment of chronic nonmalignant pain.“Chronic nonmalignant pain” is defined as pain unrelated to cancer or rheumatoid arthritis which persists beyond the usual course of disease or the injury that is the cause of pain or more than 90 days after surgery.
2.Protocol applies to everyone except:
•Board-certified anesthesiologists, physiatrists, or neurologists
•Board-certified physicians who have completed fellowship training in pain medicine
•Board-certified physicians who have surgical privileges at a hospital or surgery center and primarily provide surgical services
Process:
1.Physician must be designated as a controlled substance prescriber on his or her Physician’s Practitioner Profile, through XXXXX in Administration, prior to writing any controlled substance prescription for the treatment of chronic nonmalignant pain.
2.Patient must be seen by a controlled substance registered physician for a complete medical history and physical examination prior to beginning treatment. At that time:
•Treatment plan will be established
•Controlled substance agreement signed
•Photo ID will be copied
•Medical record will be updated
3.Patient and physician must sign the White Wilson approved Controlled Substance Contract revised 02/2012 or later. This contract must be witnessed and scanned into the medical record.
4.Prior to writing a controlled substance prescription, physicians must query E-FORCSE (Florida Prescription Drug Monitoring Program) to review for any controlled substance the patient has been prescribed.
5.Duplicates of any hand written prescriptions for controlled substances are required to be scanned into the patient medical record.
6.Patient will follow up with registered physician at regular intervals, not to exceed three months, to reevaluate treatment plan.
First Office Visit:
A complete medical history and physical examination is required prior to beginning any treatment.
1. Minimum required documentation:
•Nature and intensity of pain
•Current and past treatments for pain
•Underlying or coexisting diseases or conditions
•Effect of the pain on physical and psychological function
•Review of previous medical records
•Previous diagnostic studies
•History of substance and alcohol abuse
•Recognized medical indication for the use of a controlled substance
•Evidence of discussion regarding risks and benefits of the use of controlled substances, including therisks of abuse, addiction, physical dependence and its consequences
- A written, individualized treatment plan must be developed for each patient and must include, at a minimum:
•Objectives to be used to determine treatment success (i.e. pain relief and improved physical and psychosocial function)
•Other potential treatments or diagnostic evaluations that are planned
•Other treatment modalities (including a rehabilitation program) must be considered, depending on the etiology of the pain and the extent to which the pain is associated with physical and psychosocial impairment. This must be documented as well.
Follow-up Office Visits:
- Registered physician must examine patient at regular intervals, not to exceed three months, in order to:
•Assess efficacy of treatment
•Ensure that controlled substance therapy remains indicated
•Consider adverse drug effects
•Review etiology of pain
•Evaluate the patient’s progress toward objectives
•Monitor patient compliance with medication usage, related treatment plans, controlled substance contract, and indications of substance abuse, misuse or diversion
2.Modification/continuation of current treatment should depend on the patient’s progress. If treatment goals are not being met, despite medication adjustments, the physician should reevaluate the appropriateness of the current treatment plan.
In cases where a patienthas a history of substance abuse or a comorbid psychiatric disorder:
•Pain management requires extra care, monitoring, documentation and consultation with or referral to an addictionologist or psychiatrist.
•If the treating physician feels that the patient is at risk for misusing their medication or the patient’s living arrangement is such that there is a risk for misuse or diversion of medication, the patient should be referred for additional evaluation and treatment in order to achieve treatment objectives.
In cases where a patienthasdemonstrated signs or symptoms of substance abuse:
•Patient must be immediately referred to a board-certified pain management physician, an addiction medicine specialist, or a mental health addiction facility.
•During the period of time before a report is received from the consultant, the prescribing physician must clearly and completely document medical justification for continued treatment with controlled substances, and the steps taken to ensure medically appropriate use of controlled substances by the patient.
•Upon receipt of the consultant’s written report, the prescriber must incorporate the consultant’s recommendation for continuation, discontinuation or modification of controlled substance therapy. All resulting changes must be documented in the patient’s medical record.
Evidence or behavioral indications of diversion of medication will be followed by discontinuation of controlled substances and discharge. Copies of tests and letter of disengagement must be placed in patient medical record.