Acute Pain Limit (OBON 30-MED) Rule Change Update
Last Monday, December 11, OAAPN President Jesse McClain gave testimony to the Joint Committee Agency on Rule Review (JCARR) about the Ohio Board of Nursing’s (OBON) amended rules on acute pain prescribing. The basis of the testimony was that Ohio APRN practice was being changed at its foundation: Collaboration.
The OBON’s amended rules accepted the Board of Medicine’s (BOM) language that the treating physician is singularly accountable for acute pain prescribing above 30 MED due to major surgery, injury or medical condition. It was this language that places APRNs under the physician’s supervisory control when treating acute pain. The OBON stated that the rule did not mention supervision or delegation; yet, when one MUST check with a treating/ prescribing physician before an acute pain greater than 30 MED drug may be prescribed, this action fits the definition of supervision.
The rule, which may be effective as early as January 1, 2018, will affect SCAs for APRNs who prescribe greater than 30-MED drugs for acute pain. An APRN must be in collaboration with the treating physician to prescribe greater than 30 MED drugs for acute pain. While this rule change may not adversely affect hospital APRNs who have collaborative arrangements with the service line physicians, it will affect all others. If a primary care APRN sees an acute pain patient because the 30 MED prescription was not long enough, and the patient can’t get an appointment to see the treating physician timely, the patient suffers. The only recourse for this patient, besides seeing an APRN who has a plethora of SCAs with almost every physician in the county, would be the Emergency Department.
During the testimony, the OBON gave its rationale for the rule amendment and the process. The original rule the OBON wrote was restrictive and without any medical exceptions. Additionally, some APRNs decried to the OBON that physician assistants could prescribe greater than 30 MED due to the physician supervision relationship. The OBON, without working with APRN stakeholders, modified the rule with parity as its focus. This focus, while well-intentioned, was flawed resulting in unintended consequences. APRNs collaborate and are not supervised. A physician cannot delegate aspects of prescriptive authority to an APRN as is done with physician assistants.
The OBON president reported that the APRN Advisory Council voted 6-2 in favor of this supervisory change. At the October Council meeting, APRNs were given the option of keeping the original rule or change to the BOM’s language, no other. The council thought impeded work flow in the hospitals could negatively impact Ohioans and voted in favor of supervision of APRNs when prescribing for acute pain.
The impact of this amended rule has now placed Ohio in a restricted practice state instead of reduced practice. In the end, JCARR upheld the rule “despite concerns from nurses.”
OAAPN did not win this effort, yet the push for Ohio APRN practice change continues. When OAAPN finally achieves full practice authority the OBON will no longer be able to cede its authority to the BOM on APRN practice. OAAPN extends its gratitude to all members who helped with this endeavor!