The new rule relating to Texas Nurses' authority to order and prescribe controlled substances will take effect September 1, 2019.
Reason for the Amended Rule
The amendment is necessary for compliance with the statutory mandates born of Texas House Bill 2516 and it removes outdated and obsolete references from the sections. HB 2516, among other things, requires advanced practice registered nurses (APRNs) to access the Texas Prescription Monitoring Program (PMP) prior to prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol. The bill became effective on September 1, 2017.
The Texas Prescription Monitoring Program (PMP) was created to be a tool to help control misuse of controlled substances and to generate and disseminate information regarding prescription trends.
Requirements of the Amended Rule
Chapter 222 of the Texas Administrative Code sets forth the general requirements applicable to APRNs with prescriptive authority. Section 222.8 sets forth the specific requirements applicable to APRNs prescribing controlled substances. The language of the rule has remained largely the same as it was prior to the adopted amendments.
Under the amended §222.8(a) an APRN must "comply with all federal and state laws and regulations relating to the ordering and prescribing of controlled substances in Texas, including but not limited to, requirements set forth by the United States Drug Enforcement Administration." APRN compliance with the Texas Department of Public Safety has been removed. 22 Tex. Admin. Code §222.8(a) as amended.
Further, an entire section has been added under this amendment:
(d) Prescription Monitoring Program (PMP).
- APRNs should access and review the prescription monitoring program (PMP) authorized by Chapter 481, Health and Safety Code, prior to prescribing any controlled substance for patients being treated for pain.
- APRNs must access and review the PMP before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol unless:
- the patient has been diagnosed with cancer or the patient is receiving hospice care; and
- the APRN clearly notes on the prescription or in the electronic prescription record that the patient was diagnosed with cancer or is receiving hospice care, as applicable.
- An APRN will not be subject to disciplinary action if the APRN:
- makes a good faith attempt to access and review the PMP prior to prescribing opioids, benzodiazepines, barbiturates, or carisoprodol, but is unable to access the information because of circumstances outside the control of the APRN; and
- clearly notes on the patient's prescription or in the patient's electronic prescription record the APRN's attempt to access and review the PMP and the circumstances that prevented the APRN from being able to do so.
- Documentation that the review of the PMP occurred and rationale for prescribing a controlled substance must be included in the patient's medical record.
- This section takes effect September 1, 2019.
22 Tex. Admin. Code § 222.8(d) as amended.
On and after September 1, 2019 all Texas APRN's must comply with the above and access PMP prior to prescribing any controlled substance for patients being treated for pain.
Adoption of amendments to § 222.8 were approved by the BON at its July 2018 meeting for submission to the Texas Register for public comment. The proposed amendment was published in August and the public comment period ended in September, 2018. The Board considered the one comment submitted from the public at its October 2018 meeting and the amendment was adopted. The amended rule on Texas nurses ordering and prescribing controlled substances becomes effective September 1, 2019, consistent with the statutory mandates of Texas House Bill 2516.
Complaints Against Texas Nurses
If you have been notified of a complaint filed against you with the Texas Board of Nursing, BERTOLINO LLP can help. We are experienced BON license defense attorneys and we know how to navigate the BON's complaint process. We are prepared to represent you at any legal hearing or proceeding regarding your professional license.
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