The Texas Board of Nursing (BON) licenses and regulates nurses, including advanced practice registered nurses (APRNs). As a result, the BON must ensure that APRNs follow all applicable laws and rules. Any violations by APRNS, including those related to prescribing controlled substances, can lead to disciplinary proceedings and potentially severe sanctions. As a result, all APRNs must be knowledgeable about and follow the laws and rules that govern their profession.
If you face disciplinary proceedings before the BON, consulting a nursing license defense lawyer to defend your license can be crucial. By enlisting a strong legal advocate from the outset of your case, you may be better positioned to reach a more positive resolution.
Guidelines for APRNs Prescribing Controlled Substances
The BON has issued specific “Guidelines for the Responsible Prescribing of Opioids, Benzodiazepines, Barbiturates, Carisoprodol (Soma), and Other Controlled Substances,” which apply to all APRNs who prescribe controlled substances. In these Guidelines, the BON states that APRNs must comply with 22 Tex. Admin. Code §222 et seq., which addresses the prescriptive authority of APRNs and that APRNs who provide pain management services must follow 22 Tex. Admin. Code §228 et seq., which addresses the use of controlled substances in pain management.
Authority of APRNs to Order and Prescribe Controlled Substances
Under 22 Tex. Admin. Code §222.8, APRNs with full licensure and a valid prescription authorization number can obtain authority to order and prescribe certain categories of controlled substances. APRNs must follow all state and federal laws concerning the ordering and prescribing of controlled substances, including requirements set forth by the U.S. Drug Enforcement Administration (DEA).
More specifically, APRNs may order and prescribe controlled substances in Schedules III through V that meet the following conditions:
- Prescriptions, including refills, should not exceed a 90-day supply;
- Beyond the initial 90-day supply, the refill of an eligible controlled substance shall not be authorized before consulting with the delegating physician and notation of the consultation in the patient’s chart; and
- Prescription of an eligible controlled substance shall not be authorized for a child under the age of two before consulting with the delegating physician and notation of the consultation in the patient’s chart.
APRNs may order and prescribe Schedule II controlled substances only in the following circumstances:
- In a hospital-based facility, practice according to the policies developed by the hospital’s medical staff or a committee thereof as provided by the hospital’s by-laws to ensure patient safety and as part of care provided to a patient who:
- Has been admitted to the hospital for a stay of 24 hours or longer; or
- Is receiving services in the emergency department of the hospital;
- As part of the plan of care for a person who has executed a written certificate of a terminal illness, has elected to receive hospice care, and is receiving hospice treatment from a qualified hospice provider.
The Texas Prescription Monitoring Program
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APRNs should access and review the Texas Prescription Monitoring Program (PMP) before prescribing any controlled substance but are required by law to check the PMP before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol (Soma). However, an APRN is not required to check the PMP before prescribing these substances if the patient has been diagnosed with cancer or is receiving hospice care, and the APRN clearly notes that fact on the prescription or in the electronic prescription. The PMP collects and monitors prescription data for all controlled substances dispensed by pharmacies in the state or to state residents from pharmacies located in another state.
APRNs and Pain Management Care
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22 Tex. Admin. Code §228.1 addresses the duties of the APRN in prescribing controlled substances in the pain management setting. This section advises that APRNs must prescribe medications in a therapeutic manner that helps rather than harms the patient. They should treat pain according to the current standard of care and as supported by evidence-backed research and sound clinical judgment after complete patient assessment.
More specifically, APRNs working in pain management must complete a full health history and physical assessment for each patient. They also must develop a written treatment plan that includes a written explanation of how the medication ordered or prescribed relates to the chief complaint(s) and treatment of pain. The plan also must contain the name, dosage, frequency, and quantity of any medication prescribed and the number of refills authorized, other treatments authorized or considered, laboratory and diagnostic testing ordered, and ongoing monitoring to measure outcomes. Finally, the plan must contain the patient’s informed consent and all consultations and referrals.
If the patient’s treatment plan includes medication beyond 90 days, the patient must sign a written pain management agreement, which contains the following:
- Lab testing for drug confirmation upon request;
- Adhere to the number and frequency of prescription refills;
- Use only one provider for all controlled substances prescriptions for pain;
- Use only one pharmacy for all controlled substances prescriptions for pain;
- Acknowledge potential consequences of noncompliance with the agreement; and
- Acknowledge processes following successful completion of treatment goals, including weaning of medications.
Suppose a patient fails to make progress in pain management, and the APRN recommends the continued use of controlled substances to manage pain. In that case, the APRN must first consult with the delegating physician and document that consultation in the patient’s record. Additionally, if a patient exhibits a current risk for or a history of substance use disorders, addiction, or co-existing psychological or psychiatric disorders, APRNs must make the appropriate referrals.
We Will Represent Your Interests Before the BON
We know how important it is for you to maintain your APRN license and work in your chosen field. All too often, a simple misstep or oversight can lead to disciplinary proceedings and unwanted sanctions, which can threaten your license and career. The experienced nursing license defense attorneys at Bertolino LLP, will advocate to help you protect your rights throughout any disciplinary proceedings. Together, we will work to develop the defense strategy that is best calculated to maintain your license and professional future. Call us at (512) 515-9518 or contact us online.
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