(1) The advanced registered nurse practitioner shall consider and document referring the patient for additional evaluation and treatment as needed to achieve treatment objectives. Special attention should be given to those chronic noncancer pain patients who are under eighteen years of age, or who are at risk for medication misuse, abuse, or diversion. The management of pain in patients with a history of substance abuse or with comorbid psychiatric disorders may require extra care, monitoring, documentation, and consultation with, or referral to, an expert in the management of such patients.
(2) The mandatory consultation threshold for adults is one hundred twenty milligrams morphine equivalent dose (MED)(oral). In the event an advanced registered nurse practitioner prescribes a dosage amount that meets or exceeds the consultation threshold of one hundred twenty milligrams MED (orally) per day, a consultation with a pain management specialist as described in WAC 246-840-493
, is required, unless the consultation is exempted under WAC 246-840-487
. Great caution should be used when prescribing opioids to children with chronic noncancer pain and appropriate referrals to a specialist is encouraged.
(a) The mandatory consultation shall consist of at least one of the following:
(i) An office visit with the patient and the pain management specialist;
(ii) A telephone consultation between the pain management specialist and the advanced registered nurse practitioner;
(iii) An electronic consultation between the pain management specialist and the advanced registered nurse practitioner; or
(iv) An audio-visual evaluation conducted by the pain management specialist remotely, where the patient is present with either the advanced registered nurse practitioner or a licensed health care practitioner designated by the advanced registered nurse practitioner or the pain management specialist.
(b) An advanced registered nurse practitioner shall document each mandatory consultation with the pain management specialist. Any written record of the consultation by the pain management specialist shall be maintained as a patient record by the specialist. If the specialist provides a written record of the consultation to the advanced registered nurse practitioner, the advanced registered nurse practitioner shall maintain it as part of the patient record.
(3) Nothing in this chapter shall limit any person's ability to contractually require a consultation with a pain management specialist as defined in WAC 246-840-493
, at any time. For the purposes of WAC 246-840-460
, "person" means an individual, a trust or estate, a firm, a partnership, a corporation (including associations, joint stock companies, and insurance companies), the state, or a political subdivision or instrumentality of the state, including a municipal corporation or a hospital district.
[Statutory Authority: RCW 18.79.400. 11-10-064, § 246-840-485, filed 5/2/11, effective 7/1/11.]