MISSISSIPPI BOARD OF NURSINGADVANCED PRACTICE REGISTERED NURSES (APRNS) : 2015 UPDATES

Mississippi Board of Nursing

Lynn Langley, DNP, FNP-BC, ANP-BC, CPHQExecutive Director

& Phyllis Johnson, MSN, MS, FNP-BC

Director of Advanced Practice

Mississippi Nurse Practice Law

Mississippi Board of Nursing

Legally charged to protect the public by regulating the practice of Nursing.

Mississippi Nurse Practice Act defines the practice of nursing; (73-15-5)

Administrative CodeMississippi Board of Nursing

Mississippi Administrative CodeTitle 30: Professions and Occupations

Parts 2801 – 2900 The authority of the Mississippi Board of

Nursing is to promulgate rules and regulations for the licensure of registered nurses, advanced practice registered nurses, licensed practical nurses, expanded role licensed nurses and certified hemodialysis technicians as provided for in the laws of the Miss. Code Ann. Sections 73-15-17 (a), &73-15-101.

Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) in Mississippi

Registered Nurses, approximately: 45,000

APRNs account for approximately: 3751 CRNAs – 750 CNM – 56 CNP – 2,945 Special areas of

concern***

APRNs in Mississippi – Collaboration State Law

• Each APRN must have one collaborating physician who will be available to… – Review

protocols/agreement.– Collaboration/

consultation at all times APRN is practicing.

– Agrees to implement Quality Assurance Plan with APRN and make quarterly face to face visits with the APRN to review for QA.

– Recommend a secondary collaborating physician.

Quality Assurance (QA)Review

Sample size: 10% of patients seen

per month or …. 20 charts (which ever

is less)

Monthly review

Quarterly -sign by collaborating physician and APRN

MSBN QA Requirements

If APRN consulted with the collaborating physician, this will count as a review.

Put this on your log.Keep records for

seven (7) years.QA log kept at

primary practice site.

Protocol/Agreement

MBML wants signed protocol on site. Be sure physician reads protocol

APRN must have an agreement with a collaborating physician before practicing. (Recommend a signed copy.**)

Important that physician and APRNs reads and understands protocol/agreement.

MSBML - Collaboration

Rule 1.2 Definitions. For the purpose of Part 2630, Chapter 1 only, the following terms have the meanings indicated:

A. “Physician” means any person licensed to practice medicine or osteopathic medicine in the state ofMississippi who holds an unrestricted license or whose practice or prescriptive authority is not limitedas a result of voluntary surrender or legal/regulatory order.

B. “Free Standing Clinic” means a clinic or other facility wherein patients are treated by a nursepractitioner, which is more than fifteen (15) miles away from the primary office of thecollaborative/consultative physician. Excluded from this definition are all licensed hospitals, statehealth department facilities, federally qualified community health clinics and volunteer clinics.

C. “Primary Office” means the usual practice location of a physician and being the same locationreported by that physician to the Mississippi State Board of Medical Licensure and the United StatesDrug Enforcement Administration.

D. “Collaborating/Consulting Physician” means a physician who, pursuant to a duly executed protocol has agreed to collaborate/consult with a nurse practitioner.

E. “Nurse Practitioner” means any person licensed to practice nursing in the state of Mississippi and certified by the Mississippi Board of Nursing to practice in an expanded role as a nurse practitioner.

F. “Advanced Practice Registered Nurse” includes all nurse practitioners, certified nurse midwives and certified registered nurse anesthetists.

Source: Miss.

APRN & Collaborating Physicians

An APRN must have a collaboration physician who has an unrestricted license in Mississippi.

Recommend backup collaborating physician.

APRN Practice Site

APRN must have a practice site prior to beginning practice.

This is a problem!!!

Collaborating Physician and APRN

Physician and APRN must have a comparable or “same “like” practice.

Why Not….

Joined at the “hip” does NOT meet the intent of either boards’ requirements for QA activities.

What’s New? MSBP – Prescription Monitoring Program

The Mississippi Prescription Monitoring Program (MS PMP) is managed by Mississippi Board of Pharmacy. The Mississippi Prescription Monitoring Program, MS PMP, is Mississippi solution for monitoring Schedule II-V controlled substances dispensed in Mississippi.

Mississippi State Statutes 73-21-127, 73-21-97 and 73-21-103 set forth the legal requirements for reporting Schedule II-V controlled substances dispensed in Mississippi for use in the PMP system. Similarly, any drug containing Ephedrine or Pseudoephedrine is to be reported as a schedule III, and any drug containing Tramadol or Butalbital is to be reported as a schedule IV.

Mississippi Board of Pharmacy- PMP

Information about controlled substance dispensing activities is reported regularly to the state of Mississippi through the authorized data collection vendor.

Pharmacies and other dispensers (clinics, etc.) are required by law to provide such reporting to the data collection vendor in approved formats and frequencies. This includes mail order pharmacies that routinely mail orders into the state.

Mississippi PMP

Mississippi began collecting information in April 2005.

Reports available to law enforcement in October 2005.

State Law – Doctor Shopping

PMPi is the Interconnect between states. Not all states are on board.

We currently share with 10 states – AR, TN, ND, AZ, IL, KS, MN, NM, MI, ID

MS PMP

The primary beneficiaries of Mississippi PMP are patients throughout Mississippi.

Because of the Mississippi PMP, healthcare providers can make better and more informed treatment decisions that allow them to provide the most appropriate medical care for their patients.

All Mississippi citizens ultimately benefit through improved medical care and reductions in the abuse and diversion of controlled substance prescription drugs. (Above information from Mississippi State Board of Pharmacy)

What is the requirement for enrolling in the Mississippi Prescription Monitoring Program (MS PMP) and how do I get enrolled?

Enrolled in the Mississippi Prescription Monitoring Program (PMP)

All Physicians must have been enrolled in MS PMP by December 2013. Regulated by MS BOML.

May delegate to assist with PMP.

CNPs, CNMs and CRNAs (who work in a pain clinic only), must have been enrolled in the MS PMP by December 2014. Regulated by MS BON.

May delegate to a licensed nurse to assist with PMP.

Controlled Substances

Boards of Nursing have information about state’s laws that determine if you are eligible to prescribe controlled substances (CSs).

In some states prescribing CSs may be limited to a certain APRN role such as a nurse practitioner.

In states where there is delegation of prescriptive authority or that require collaboration or supervision for APRN prescribing there may be special requirements for eligibility.

Why are Regulator Boards Requiring Enrollment in the PMP?

Prescription drug abuse has become the

#1 healthcare problem in the nation.

Red Flags

Among the prescription medication frequently seized by the Mississippi Bureau of Narcotics are OxyContin, Lorazepam, hydrocodone and Xanax

*Holy Trinity

Why Change is Needed

Drug overdose death rates have been rising steadily since 1992 with a 102% increase from 1999 to 2010 alone.

In 2010, 30,006 (78%) of the 38,329 drug overdose deaths in the United States were unintentional, 5,298 (14%) of suicidal intent, and 2,963 (8%) were of undetermined intent.

Controlled Substance

In 2012, 90 percent of overdose deaths in Mississippi were caused by prescription drugs, and most were accidental.

Proper storage and disposal of medications can prevent injuries and deaths from drug abuse and drug overdoses.

Mississippi is ranked #30 nationally on drug overdose.

National Survey on Drug Use and Health, roughly 2.8 million people aged 12 or older had illegally used the prescription drug OxyContin at least once.Mississippi has ordered opiods 6.1/10,000 with national average 7.1/10,000

Reason for Improvement

Health care environments are recognizing and reshaping their services to meet the needs of the transition in the cultural diversity and complexion of communities across the country.

Shifting regulatory landscape. Federal health policymakers and private foundations are making changes based on the Affordable Health Care Act.

Making the mistake that you think you know everything.

Individual behavior occur in context of a particular environment.

(Lee, 2006)

Tip of the iceberg.

Paradigm Shift

Culture – Woodstock to Now

Barriers

Highest risk factors associated with prescription drug abuse are …. rurality and poverty.

Where do providers work?

Rural and Poverty Areas

Mississippi is 46,907 square miles, (82 counties) with 60% of population living in rural areas and 20% of the population living in poverty.

Educate --Educate

Every eight minutes a child is treated in the ER for drug overdose (more than fatal car accidents).

Drugs are obtained from individuals “medicine cabinets”.

Education must be implemented for storage of medication correctly.

DEA Practitioner’s Manual

2006 Edition Joseph T. Rannazzisi

Deputy Assistant AdministratorOffice of Diversion Control

Mark W. CaverlyChief, Liaison and Policy Section

This manual has been prepared by the Drug Enforcement Administration, Office of Diversion Control, to assist practitioners (physicians, dentists, veterinarians, and other registrants authorized to prescribe, dispense, and administer controlled substances) in their understanding of the Federal Controlled Substances Act and its implementing regulations as they pertain to the practitioner’s profession.

National Investigation of Drug and Diversion Association (NIDDA)

Great example is NIDDA organization.

Nurses must be involved in order to make change.

Educational Classes

APRN New Graduate mandatory orientation classes implemented in October 2012.

New APRNs were losing their license to practice based on deficient controlled substance prescribing practices.

Schedule II, Controlled Substances

These drugs have a high potential for abuse that may lead to severe psychological or physical dependence.

Examples include: Morphine, methadone (Dolophine®), meperidine

(Demerol®), fentanyl (Duragesic®) Oxycodone (Percocet®, Oxycontin®), hydromorphone

(Dilaudid®) Amphetamines (Dexedrine®, Adderall® ,(Ritalin®,

Concerta®) Cocaine, amobarbital and pentobarbital Effective October 6, 2014, Hydrocodone (Examples

Lortab, Norco, Vicodin, etc.) changed to a Scheduled II.

Documentation: Controlled Substances

Complete record of examination including- Diagnosis Reason for prescribing

Controlled Substance Name Dose Strength Quantity Date Refills (Should limit to one,

however until Administrative Code changed has five)*

Documentation: Controlled Substances

Good faith agreement or contract.

Patient treatment goals.

Follow up.

Thank You for Your Kind Attention

Questions??