Controlled substance documentation

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noestervemb
Posts: 59
Joined: Sat Jul 09, 2016 7:45 am

Controlled substance documentation

Post by noestervemb » Tue Apr 25, 2017 8:21 am

The Virginia Dental Board just imposed rules to combat the opioid crisis. I am assuming other state boards either already did or is going to do so. I posted below some of the requirements. The way i am going to make it work now is i made a long auto note to documents all of their requirements and how much MEE/day (morphine equivalent a day) i am prescribing. If they are taking a benzodiazepine, hypnoticsedative etc i also have to give them a Naloxone RX (a reversal agent for opioids). I was thinking of adding a medication alert under the RX setup to automatically alert me in case i forget.

It would be nice to have an option of an auto popup when printing a controlled substance to add the required documentation. Just what i thoight would be easiest. Before i submit a feature request does anybody else have any suggestions or ideas?


Requirements below
A
definition for acute pain to mean pain that occurs within the normal course of a disease or condition or as the result of surgery for which controlled substances may be prescribed for no more than three months. The
definition for chronic pain means nonmalignant pain that goes beyond the normal course of a disease or condition for which controlled substances may be prescribed for a period greater than three months.
Requires that non-pharmacologic and non-opioid treatment for pain shall be given consideration prior to treatment with opioids. If an opioid is considered necessary for the treatment of acute pain, the practitioner shall give a short-acting opioid in the lowest effective dose for the fewest possible days.
Requires that prior to initiating treatment with a controlled substance for a complaint of acute pain, the prescriber must perform a history and physical examination appropriate to the complaint, query the Prescription Monitoring Program as set forth in the Code of Virginia and conduct an assessment of the patient's history and risk of substance abuse.
Initiation of opioid treatment for patients with acute pain shall be with short-acting opioids. When prescribing a controlled substance containing an opioid, a practitioner is limited to a quantity that do not exceed a seven-day supply as determined by the manufacturer's directions for use, unless extenuating circumstances are clearly documented in the patient record.
Sets the following limits on dosages: 1. The dentist must carefully consider and document in the patient record the reasons to exceed 50 MME/day. 2. Prior to exceeding 120 MME/day, the dentist must document in the patient record the reasonable justification for such doses and shall refer to or consult with a pain management specialist. 3. Naloxone must be prescribed for any patient when risk factors of prior overdose, substance abuse, doses in excess of 120 MME/day, or concomitant benzodiazepine is present.
When an opioid is prescribed for more than 7 days, the patient must be re-evaluated, the need for continued prescribing must be documented in the patient record, and the dentist must check the PMP.
Requires that the patient record include a description of the pain, a presumptive diagnosis for the origin of the pain, an examination appropriate to the complaint, a treatment plan and the medication prescribed or administered to include the date, type, dosage, and quantity prescribed.
Sets out the requirements for prescribing opioids for treatment of the chronic pain patient. If a dentist treats a patient for whom an opioid prescription is necessary for chronic pain, he shall either: 1. Refer the patient to a medical doctor who is pain management specialist; or 2. Comply with regulations of the Board of Medicine, 18VAC85-21-60 through 18VAC85-21-120, if he chooses to manage the chronic pain with an opioid prescription.
Requires any dentist who prescribes any Schedule II through IV controlled substances during one renewal cycle shall obtain two hours of continuing education on pain management during the next renewal cycle following the effective date of this regulation (the course must be completed between 3-31-18 and 3-31-19). Continuing education hours required for prescribing of controlled substances may be included in the 15 hours required for renewal of licensure.

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Arna
Posts: 444
Joined: Tue Jul 09, 2013 3:16 pm

Re: Controlled substance documentation

Post by Arna » Tue May 02, 2017 10:10 pm

The most glaring thing I see that will get in the way of your FR is the fact that you have to mark any drug as controlled in Open Dental in order for the DEA # to print on Rx, which means most drugs in OD are flagged as controlled substances.

You could solicit the use of automation (you'd still need a FR I think) to assist with this, if there were a trigger for create Rx. There would have to be a way to note which Rx you want to get an alert for.
Entropy isn't what it used to be...

Arna Meyer

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