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Oregon Administrative Rules
Written notice disclosing the material risks associated with prescribed or administered controlled substances for the treatment of "intractable pain."
847-015-0030 (1) If in the clinical judgement of the attending physician and at least one consulting physician specializing in an area of practice thought to be the source of the intractable pain (chronic non-malignant pain) as defined in ORS 677.470(2), controlled substances may be prescribed for long term treatment of "intractable pain." ORS 677.475(1) The attending physician records must contain the attending physician's examination, diagnosis and any other supporting diagnostic evaluations and other therapeutic trials as well as written documentation by the consulting physician of corroborating findings, diagnosis and recommendations.
(2) Before initiating treatment of "intractable pain" with controlled substances, the attending physician shall discuss with the patient the material risks associated with the prescribed or administered controlled substances. Following the discussion the patient may request further explanation prior to signing the material risks notice. Following completion of the discussion, the attending physician shall provide to the person and the person shall sign a written notice of the material risks associated with the prescribed or administered controlled substances to be prescribed, ORS 677.485.
(3) The material risk notice should include but not be limited to:
(a) The diagnosis;
(b) The controlled substance and/or group of controlled substances to be used;
(c) Anticipated therapeutic results;
(d) Alternatives to controlled substance therapy; and
(e) Potential side effects (if applicable):(A) General;
(B) Central Nervous System;
(C) Gastrointestinal;
(D) Respiratory;
(E) Dermatologic, and
(F) Other.
(f) Allergy Potential,
(g) Interaction/Potentiation of other medications;
(h) Potential for dose escalation/tolerance;
(i) Withdrawal precautions;
(j) Potential for dependence and addiction;
(k) Potential for impairment of judgement and/or motor skills;
(l) Satisfaction with or desire for more explanation; and
(m) Patient signature (dated)
(4) The material risk consent form will be maintained as a permanent component of the patient record as shall documentation of long term follow-up to demonstrate the continued need for this form of therapy, ORS 677.480(1)(3). A dispensing record of the amount and dose of the prescribed or administered controlled substances shall be maintained as part of the patient record.
Adopted by the board 07/26/96.
Effective date 07/26/96.