Ariz. Admin. Code § 9-10-2006

Current through Register Vol. 30, No. 49, December 6, 2024

Section R9-10-2006 - Pain Management Services

A. A medical director shall ensure that a medical practitioner or nurse anesthetist remains on the premises until all patients who received a procedure at the pain management clinic are discharged.

B. A medical director shall ensure that, if a procedure other than the administration of an opioid is used to provide pain management services:

1. Before the procedure is initially used on a patient, the patient is evaluated by:

a. A medical practitioner or

b. A nurse anesthetist, according to A.R.S. § 32-1634.04;

2. The procedure is performed by a personnel member qualified according to policies and procedures to perform the procedure; and

3. The following information is included in the patient's medical record:

a. The evaluation of the patient required in subsection (B)(1),

b. A record of the procedure, and

c. Any adverse reaction to the procedure and any measures taken to address an adverse reaction.

C. Except as provided in subsection (E), a medical director shall ensure that a medical practitioner:

1. Before prescribing an opioid for a patient of the pain management clinic:

a. Conducts a physical examination of the patient;

b. Except as exempted by A.R.S. § 36-2606(G), reviews the patient's profile on the Arizona Board of Pharmacy Controlled Substances Prescription Monitoring Program database;

c. Conducts an assessment of the patient's substance use risk;

d. Explains to the patient or the patient's representative the risks and benefits associated with use of an opioid;

e. Explains alternatives to a prescribed opioid; and

f. Obtains informed consent from the patient or the patient's representative that meets the requirements in R9-10-2007(B), including the potential risks, adverse outcomes, and complications associated with the concurrent use of an opioid and a benzodiazepine or another sedative-hypnotic medication, if the patient:

i. Is also prescribed or ordered a sedative-hypnotic medication, or

ii. Has been prescribed a sedative-hypnotic medication by another medical practitioner;

2. Before ordering an opioid for a patient of the pain management clinic:

a. Conducts a physical examination of the patient;

b. Except as exempted by A.R.S. § 36-2606(G), reviews the patient's profile on the Arizona Board of Pharmacy Controlled Substances Prescription Monitoring Program database;

c. Conducts an assessment of the patient's substance use risk;

d. Explains to the patient or the patient's representative the risks and benefits associated with the use of opioids or ensures that the patient or the patient's representative understands the risks and benefits associated with the use of an opioid as explained to the patient or the patient's representative by an individual licensed under A.R.S. Title 32 and authorized by policies and procedures to explain to the patient or the patient's representative the risks and benefits associated with the use of an opioid;

e. If applicable, explains alternatives to an ordered opioid; and

f. Obtains informed consent from the patient or the patient's representative, according to R9-10-2007(B);

3. When administering or causing administration of an opioid to a patient;

a. Before administration, identifies the patient's need for the opioid; and

b. Monitors the patient's response to the opioid; and

4. Documents the pain management services provided in the patient's medical record according to R9-10-2008.

D. A medical practitioner is exempt from the requirements in subsection (C)(2), if:

1. An order for an opioid is part of treatment for a patient in an emergency;

2. The order is issued according to policies and procedures that include procedures for;

a. Providing treatment without obtaining the consent of a patient or the patient's representative,

b. Ordering and administering an opioid in an emergency situation, and

c. Complying with the requirements in subsection (C)(2) after the emergency is resolved; and

3. The emergency situation is documented in the patient's medical record.

E. The requirements in subsections (C)(1), (2), and (3), as applicable, do not apply when:

1. A personnel member of a pain management clinic prescribes, orders, or administers an opioid as part of treatment for a patient with an end-of-life condition or pain associated with an active malignancy; or

2. A prescription for an opioid changes only the type or dosage of an opioid previously prescribed to the patient according to subsection (C)(1):

a. Before a pharmacist dispenses the opioid for the patient; or

b. If changing the opioid because the patient experienced an adverse reaction to the opioid, within 72 hours after a pharmacist dispensed the opioid for the patient.

Ariz. Admin. Code § R9-10-2006

Adopted by final rulemaking at 24 A.A.R. 3020, effective 1/1/2019.