Ohio Board of Nursing - Nursing Practice - Prescribing Resources

Exclusionary Formulary for APRN Prescribers and CTP Holders

The Exclusionary Formulary below was recommended by the Committee on Prescriptive Governance and adopted by the Board of Nursing in accordance with Sub. HB 216. It identifies the drugs that Clinical Nurse Specialists, Certified Nurse Practitioners and Certified Nurse-Midwives are absolutely prohibited from prescribing. The previous formulary that listed drugs with prescribing parameters is no longer in effect and has been removed from this webpage. It is incumbent on each Clinical Nurse Specialist, Certified Nurse Practitioner and Certified Nurse-Midwife pursuant to agreement with their collaborating physician to prescribe drugs consistent with the APRN’s certification, specialty, and standard care arrangement.

  Adobe Acrobat FileExclusionary Formulary, Adopted May 17, 2017


General Information

   Adobe Acrobat FilePrescriber Number is Required on All Prescriptions

   Internal Page LinkClick Here for Prescriptive Authority Verification

   Internal Page LinkClick Here for Prescriptive Authority Application

   Internal Page LinkDrug Enforcement Administration (DEA) Registration & Validation -(Includes link to Practitioner’s Manual.)


Resources

Internal Page Link Ohio Automated Rx Reporting (OARRS) System

Internal Page LinkOhio Opioid Prescribing Resouces

Internal Page LinkOhio's Initiatives to Fight Opiate and Prescription Abuse

Internal Page LinkOhio Opioid Prescribing Guidelines

Adobe Acrobat FileOhio Guidelines for Management of Acute Pain Outside of Emergency Departments

Adobe Acrobat FileOhio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain

Adobe Acrobat FileOhio Guidelines for Emergency and Acute Care Facility Opioid and Other Controlled Substances (OOCS) Prescribing

Internal Page LinkInteractive Online Opioid Mapping Tool

Internal Page LinkPrevention of Neonatal Abstinence Syndrome

Internal Page LinkFacts and Comparisons - Online
(Facts and Comparisons subscription required.)



LICENSURE DEADLINE EXTENDED (Pharmacy Board Resolution, Adopted 6/6/2017)

The requirement to obtain a license as a terminal distributor with an office-based opioid treatment classification has been extended and now takes effect on October 31, 2017. The extension of the licensure deadline will allow the Board additional time to review and process license applications.

A copy of the Board’s resolution authorizing the extension can be accessed here: www.pharmacy.ohio.gov/obot

As a reminder, the OBOT application can be accessed here: www.pharmacy.ohio.gov/OBOTapplication



SPECIAL NOTICE REGARDING OBOT PROVIDERS (Pharmacy Board Resolution, Adopted 6/6/2017)

The Board recognizes that those providing office-based opioid treatment (including prescribers, nurses and counselors) may have a history of substance-use disorder. Such a history does not automatically preclude a provider from practicing/working at a facility or serving as the responsible person for the facility (i.e. physician) if that provider complies with the terms of the provider’s applicable probation or consent agreement and can demonstrate a pattern of sustained recovery.

Information documenting a provider’s recovery should be submitted along with all copies of relevant documents (such as court pleadings or orders, or other agency orders/dispositions) with the facility application.


Important Update from OARRS

On April 25, 2017, the Ohio Automated Rx Reporting System (OARRS) upgraded to its new software platform. While every attempt was made to ensure a smooth transition, the Pharmacy Board is aware of some access issues and is working diligently to correct these issues.

For those currently experiencing access issues, please be aware of the following:

The new system uses e-mail addresses rather than user names. If you do not recall the e-mail address linked to your OARRS account, you will have to contact the Pharmacy Board at 614-466-4143 option 1, or by email at info@ohiopmp.gov. Due to the upgrade, we are experiencing higher volumes of phone calls and emails than usual. We will address your issue as soon as we can.

The new system cannot import your previous password. All users are required to reset their passwords when they login for the first time. To reset your password, use the Password Reset link on the login page. If your account is not able to be found, please register for a new account. If you are otherwise unable to reset your password, please call the Pharmacy Board at 614-466-4143 option 1.

For all other inquiries:

Technical Support:
844-464-4767

Account Inquiries
614-466-4143
info@ohiopmp.gov


New Opioid Overdose Prevention Microsite

CDC’s Division of Unintentional Injury and Prevention is pleased to announce a new resource to support your efforts to address the opioid epidemic, the Opioid Overdose Prevention for State Microsite. It offers a simple way for you to share opioid overdose prevention information directly through your own website. All content is maintained by CDC and syndicated to your website, meaning once embedded the microsite will automatically keep your site current with the latest content. Click here to learn more about this resource and to download it for free.


New Online Training for Providers

DUIP launched the first in a series of interactive, online trainings for healthcare providers. These trainings feature the recommendations in the Guideline for Prescribing Opioids for Chronic Pain, providing sample scenarios, feedback, and resources. This series is intended to help healthcare providers communicate effectively with patients about opioid use, decide when to initiate or continue opioid therapy, offer appropriate nonopioid options for pain management, and assess and address risks and harms of opioid use. The first training, Addressing the Opioid Epidemic: Recommendations from CDC is available for continuing education credit and can be found on the training web page.


Authorization Expanded to Qualified Certified Nurse Practitioners
for the Prescribing of Buprenorphine to Treat Opioid Addiction

The Substance Abuse and Mental Health Services Administration (SAMHSA) recently announced that Certified Nurse Practitioners (CNPs) can train and apply to become DATA-waiver practitioners to prescribe buprenorphine to treat opioid addiction, also known as medication-assisted treatment or MAT. DATA-waiver CNPs will be limited to 30 patients for MAT treatment. CNPs must complete 24 hours of required training. Previously, only physicians could obtain the DATA-waiver. Beginning in early 2017 qualifying CNPs and physician assistants can apply for the DATA-waiver.

Click Here for More Information


Drug Enforcement Administration (DEA) REVISED ANNOUNCEMENT
REGARDING RENEWAL APPLICATIONS (January 2017)

Starting January 2017, DEA will no longer send its second renewal notification by mail. Instead, an electronic reminder to renew will be sent to the email address associated with the DEA registration.

At this time, DEA will otherwise retain its current policy and procedures with respect to renewal and reinstatement of registration.
This policy is as follows:


NCSBN Makes Substance Use Disorder Educational Courses
Free to Nurses and Nursing Students

Chicago - The National Council of State Boards of Nursing (NCSBN) Board of Directors (BOD) voted to provide NCSBN courses “Understanding Substance Use Disorder in Nursing” and “Nurse Manager Guidelines for Substance Use Disorder” free of charge for all nurses and nursing students.

NCSBN BOD President Katherine Thomas, MN, RN, FAAN, executive director, Texas Board of Nursing, comments, “The chronic and complex disease of substance use disorder (SUD) is an issue of importance to U.S. boards of nursing because of the potential harm to patient welfare. Cognizant of the opioid crisis and substance use disorder’s societal impact, NCSBN is responding to the American Public Health Association’s call to action to implement evidence-based provider training programs in substance use disorder.”

NCSBN’s SUD toolkit, brochures, posters, a book and two continuing education (CE) courses. was developed to assure that nurses are armed with knowledge to help identify the warning signs of SUD in patients, nurses and the general public and provide guidelines for prevention, education and intervention.

Now all of these resources are available free of charge from www.ncsbn.org. Both CE courses award contact hours upon successful completion. Register for the courses at www.learningext.com. In addition the toolkit includes the “Substance Use Disorder in Nursing” resource manual, the “Substance Use Disorder in Nursing” video, prevention-focused posters for health care facilitates and two brochures, “What You Need to Know About Substance Use Disorder in Nursing” and “A Nurse Manager’s Guide to Substance Use Disorder in Nursing.”


Nursing Education Webinar Series on Addressing the Opioid Crisis

The American Association of Colleges of Nurses partnered with 24 national nursing organizations (including the national associations for Nurse Practitioners, Clinical Nurse Specialists and Nurse-Midwives) to offer an educational webinar series that addresses the nation's opioid epidemic. We strongly encourage all Ohio's licensees to consider obtaining continuing education in the understanding of professional responsibilities associated with safe prescribing practices, the treatment of pain, and the prevention and treatment of addiction. The free webinar series includes modules on practice guidelines and standards of care, as well as education models. The series serves as an important additional resource for practicing nurses, faculty and students. http://ncsbn.us2.list-manage.com/track/click?u=a6c6f7da1b05b0e47f0cb6193&id=0d8ea9f926&e=f23755770a


Turning the Tide on the Opioid Crisis

Addressing the opioid crisis in the United States will take a broad, comprehensive approach that engages all sectors of society. Clinicians can and should play a leading role in this crucial effort. US Surgeon General, Dr. Vivek Murthy, in partnership with Public Health Foundation Resources and100 Million Healthier Lives, recently launched TurnTheTideRx.org to equip clinicians with information and resources that can help them be active participants in the fight against this growing epidemic. For even more information on how health care can help turn the tide, please take advantage of IHI’s resources on this topic.


Opiate Prescribing Resource Website

The appropriate treatment of pain is a priority in Ohio.  The Governor’s Cabinet Opiate Action Team (GCOAT), the Nursing Board, and a group of professional health care provider regulatory boards, associations, individual providers and other key stakeholders have focused their efforts on educating health care professionals and patients.  The goal of this educational effort is to help reduce and eliminate the misuse and abuse of opioid drugs.

The website www.opioidprescribing.ohio.gov features the “Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain”, a one-hour continuing education video and information and links to an improved OARRS reporting system keyed to this initiative. 

Using the recently adopted guidelines in coordination with OARRS reports is a best practice that offers insight into a patient’s use of opioids and other controlled substances while also alerting prescribers to possibilities of medication conflicts and signs of abuse, addiction or diversion.  OARRS reports have recently been enhanced to include a dosage calculator to assist prescribers in determining whether patients are at, near or over the daily 80 MED highlighted in the guidelines.


Opioids Prescribed to Ohio Patients Decrease by 162 Million Doses Since 2012 Report Shows Continued Progress in Promoting Responsible Opioid Prescribing

The complete 2016 OARRS Annual Report can be accessed by visiting: www.pharmacy.ohio.gov/OARRS2016


Important OARRS Registration Information for CTP Holders

OARRS is the statewide database that collects information on all prescriptions for controlled substances that are dispensed by pharmacies and personally furnished by licensed prescribers in Ohio. OARRS data is available to prescribers when they treat patients, pharmacists when presented with prescriptions from patients and law enforcement officers only during active investigations. For more information on OARRS, please visit: oarrs.pharmacy.ohio.gov

Rule 4723-9-12, Ohio Administrative Code (OAC), requires that under certain circumstances APRN prescribers use the OARRS information in their practice when prescribing controlled substances. You can access Rule 4723-9-12, OAC, “Standards And Procedures For Review of OARRS,” via the link below.

To register for OARRS, go to https://www.ohiopmp.gov. The Board encourages you to register immediately so you are in compliance with this legal requirement.
Click Here to View Chapter 4723-9-12, OAC on the Lawriter Website


HB 341: OARRS Registration Requirements

Legislative initiatives of 2014 and Ohio Administrative Code rule changes continue to target prescribing of opioids, benzodiazepines and other drugs that can be dangerous when misused or abused. The Board established a link on the front page of its website, “Prescriptive Authority Resources” on this page, to provide faster access to resources supporting prescriber awareness and education.

The Board wants to remind prescribers of the following:


Ohio House Bill 314: Prescribing Opioids to Minors
Effective September 17, 2014

Effective September 17, 2014, HB 314 requires all authorized prescribers to obtain and document informed consent when prescribing a controlled substance containing opioids to a minor, unless the prescribing is done in response to a medical emergency or meets other specific circumstances set forth in statute. Thank you to the Ohio Board of Pharmacy for providing and allowing the Nursing Board to use their document as a basis for this advisory. Click here to download the advisory.


SB 110: Prescribe-Delegate Authority

SB 110: Prescribe-Delegate Authority SB 110, passed by the 131st General Assembly, authorizes CTP holders to delegate non-controlled drug administration under specified circumstances to unlicensed persons. Please click on the links below to access the statute and the Legislative Services Commission (LSC) Analysis for further details.

Effective October 15, 2015, APRNs holding prescriptive authority are authorized to delegate medication administration as specified in Sections 4723.48(C) and 4723.489, Ohio Revised Code (ORC). In doing so, APRNs must comply with standards of safe practice, including delegation, set forth in the law and rules, including Chapter 4723-13, Ohio Administrative Code (OAC). Please be aware that the new authorization in ORC Section 4723.48(C) supersedes rule language currently found in Chapter 4723-13, OAC, with respect to APRN prescribers, which previously limited the types of medication that could be delegated to an unlicensed person.

SB 110 authorizes the Board to adopt rules establishing standards and procedures for APRN delegation. The Board will convene a Board Committee on Practice meeting on January 20, 2016 at noon at the Board office to gather public input regarding the need for administrative rules.

If you have questions, please email practice@nursing.ohio.gov. To access the Ohio Revised Code and the Ohio Administrative Code, CLICK HERE.

Click Here for SB-110 - Summary


Click Here for SB-110 - Documents


New Active Cumulative Morphine Equivalent (ACME) Graph

There is a new feature, the active cumulative morphine equivalent graph, in the Ohio Automated Rx Reporting system (OARRS). This graph allows prescribers to view a patient’s ACME score for a period of time up to 24 months. To learn more about this new feature, including a sample of the new graph as part of a patient’s history report, see http://pharmacy.ohio.gov.


Accessing the Practice Insight Report on OARRS

The Practice Insight Report will provide prescribers with information about their patients. Accessing a Practice Insight Report is a simple process.

Step 1: After logging into OARRS, press the Submit link in the Requests Menu. This is the same link you press to request a Patient Rx History Report.

Step 2: In the upper left-hand corner of the request screen, above where you would enter your patient’s last name, there is a drop-down box that currently says “Patient”. Change this to Practitioner. After the screen changes, press the “Submit” button. There is no need to enter any additional information; the form is pre-populated.

Step 3: After your request has been submitted, click “View” from the requests menu. You will now see your “Practitioner” request listed among your normal “Patient” requests. Within a minute or two, your report will be ready for you to review.

The Practice Insight Report is run based on the DEA number that you provided on your OARRS registration. If you did not provide this number, or if it is out of date, please contact us at info@ohiopmp.gov to update your information.

The Board of Pharmacy believes that this new report will provide prescribers with a wealth of new information but also recognizes that many providers would like to see additional information. Health care professionals registered with OARRS can expect additional information added to the Practice Insight Report over the coming months and years as new sources of data become available.

The Board encourages OARRS users to provide feedback and suggestions regarding this report or other system improvements by emailing info@ohiopmp.gov. The Board encourages all prescribers to register with OARRS. For more information on registration, please visit: www.ohiopmp.gov.


JOINT REGULATORY STATEMENT: Prescription of Naloxone
to High-Risk Individuals Updated November 2015

The Nursing, Medical, and Pharmacy Boards originally issued a joint policy regulatory statement in April 2013 endorsing the prescription of naloxone (Narcan™) to those individuals at high-risk for opioid drug overdose. The purpose of the statement is to promote wider utilization of naloxone for high-risk individuals by educating prescribers on the proper use of naloxone.

Due to the alarming increase in drug overdose deaths, state agencies, private entities, and Ohio's professional licensing boards are working toward ways to enhance professional awareness and education regarding the prescription and use of naloxone. This joint regulatory statement approved by the Ohio Board of Nursing, Ohio Board of Pharmacy and the State Medical Board of Ohio updates previous versions of the statement, and provides an overview of Ohio's laws and programs promoting the use of naloxone for individuals at high-risk of opioid overdose.

We encourage licensees to learn more about participation in Naloxone Distribution Programs (NDPs), such as Project DAWN, and the use of the prescription of naloxone to reduce Ohio's opioid overdose epidemic. For additional information on NDPs please refer to http://www.healthy.ohio.gov/vipp/drug/ProjectDAWN.aspx.

Click Here for the 2015 Naloxone Statement

ALERT:   Prescriber Number Is Required on All Prescriptions

All nurses with prescriptive authority, whether by APRN license, or by CTP/CTP-E (through December 31 2017), are reminded that Rule 4723-9-09(I), Ohio Administrative Code (OAC), states:

A nurse holding a current valid certificate to prescribe shall satisfy all requirements for prescribing set forth in rule 4729-5-30 of the Administrative code, and shall include the nurse’s prescriber number on each prescription.

You are required to include your prescriber number on every prescription you issue. In the transition period between April 6, 2017 and December 31, 2017, your prescriber number may be either your APRN license number, or, your CTP/CTP-E number, if you have not yet transitioned to the APRN license.

In addition you must satisfy all other requirements for prescribing set forth in Pharmacy Board Rule 4729-5-30, OAC, Manner of Issuance of a Prescription. The Board of Nursing may discipline the license of any nurse for violating the Nurse Practice Act and any rules adopted under it. This includes a nurse’s failure to include a prescriber number on every prescription issued.

Chapter 4723-9, OAC, Prescriptive Authority, is available for review on the Board’s website: www.nursing.ohio.gov under the “Law and Rules" link.

Rule 4729-5-30, OAC, and all other Pharmacy Board regulations can be located on the Pharmacy Board website: www.pharmacy.ohio.gov

Click here to download the full document.


Electronic Prescribing of Controlled Substances (EPCS)

The Ohio Health Information Partnership (OHIP) through ClinicSync has released information regarding the Electronic Prescribing of Controlled Substances (EPCS). These documents discuss steps that APRNs with prescriptive authority and other Ohio prescribers must take to include the use of EPCS in their prescribing practices.

The OHIP is a nonprofit entity whose mission is to assist physicians and other providers with the adoption and implementation of health information technology (HIT) throughout Ohio, specifically in the adoption and use of electronic health records. Funded through the Office of the National Coordinator of HIT within the U.S. Department of Health and Human Services, OHIP is also responsible for the creation of a technological infrastructure that will allow Ohio physicians, hospitals and healthcare professionals to electronically share patient health records across the state.

Adobe Acrobat File EPCS Prescribers FAQs

Adobe Acrobat File EPCS Ohio Hospital and Clinic Flyer

Adobe Acrobat File Ohio Pharmacists Flyer


New Interactive Online Opioid Mapping Tool Now Available

The Centers for Medicare and Medicaid (CMS) released an interactive online mapping tool that allows the public to search Medicare Part D opioid prescription claims data at the state, county and ZIP code levels. The tool allows the user to see the number and percentage of opioid claims at the local level to better understand how the opioid epidemic impacts communities nationwide.

The mapping tool data are generated from 2013 Medicare Part D prescription drug claims prescribed by health care providers. The data set contains information from more than one million providers who collectively prescribed approximately $103 billion in prescription drugs and supplies paid under the Part D program. The data characterize the individual prescribing patterns of health providers that participate in Medicare Part D for more than 3,000 drug products. The data for each geographic region include: percentage of opioid claims, state average, national average, total providers, total opioid claims and total claims.

CDC director Tom Frieden stated that informing prescribers of this type of data can itself help reduce opioid use disorder among patients and that the mapping tool will help doctors, nurses and other health care providers assess opioid prescribing habits while continuing to ensure patients have access to the most effective pain treatment.

Interactive Online Opioid Mapping Tool Now Available


Committee on Prescriptive Governance (CPG)

About the CPG

   Adobe Acrobat FileGeneral Information About CPG Appointments
   Adobe Acrobat FileCPG Public Roster for 2017

CPG Meeting Materials -Meeting Date: May 15, 2017

  Adobe Acrobat File Upcoming CPG Meeting Agenda and Material

Updates from the CPG


NTSB Issues Recommendations for Health Care Providers

The National Transportation Safety Board (NTSB) is the federal agency responsible for the investigation of accidents in aviation and other forms of transportation. Last year, the NTSB published a safety study that focused on toxicology tests of fatally injured pilots. As a result of the study, the NTSB issued two recommendations to the state of Ohio:

(1) Include in all state guidelines regarding prescribing controlled substances for pain a recommendation that health care providers discuss with patients the effect their medical condition and medication use may have on their ability to safely operate a vehicle in any mode of transportation. (I- 14-1)

(2) Use existing newsletters or other routine forms of communication with licensed health care providers and pharmacists to highlight the importance of routinely discussing with patients the effect their diagnosed medical conditions or recommended drugs may have on their ability to safely operate a vehicle in any mode of transportation. (I-14-2)

The Board encourages prescribers to talk with patients about prescriptions that may impact their ability to safely operate a vehicle. Click Here to Download this Item

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