Missouri is so slow and 1 of 4 to go to improved pain relief

Talking Points
CURRENT STATUS FOR PRESCRIBING CONTROLLED SUBSTANCES

Missouri is One of FOUR remaining states that DOES NOT have
controlled substance prescriptive authority for APRN’s.

In addition, all surrounding states except Kentucky have some form of
controlled substance prescriptive authority for APRN’s!

HOW DOES THIS IMPACT CARE FOR MISSOURI CITIZENS?
Increased cost of care with needing to see two providers
Delays in receiving care
Increased travel time to see two providers
Lost time and wages from work due delays in treatment
Decreased efficiency in health care provider productivity
Lack of comprehensive care
Untreated or under-treated pain
Undue hardship on patients: multiple visits, absenteeism, cost of travel.
Use of less effective pain management medications (Tumolo, 2003)
Use of more expensive treatment facilities when pain is not relieved
Denied full access to APRN’s to ensure quality cancer care for individuals, families, communities, and healthcare systems (ONS, 2003)
Increased risk of disability due to unrelieved pain

IMPACT ON PATIENT CARE AND PRACTICE WHEN APRN’s ARE UNABLE TO PRESCRIBE CONTROLLED SUBSTANCES FOR PAIN MANAGEMENT:
· Scope of practice is limited (ONS, 2003)
· Less efficient use of time and resources
· Reduced quality of care for clients (Kaplan, L., & Brown, M., 2004)
· Limitations in ability to fully meet quality guidelines for pain management and end-of-life care.
· Leads to barriers to access for clients when they cannot be treated by primary provider
· Reduced job satisfaction when they see clients suffering, and in pain.
· Unmet health care needs in treatment of acute and chronic pain, and end-of-life symptom management and in providing most cost effective care.

TRENDS TO CONSIDER IN DISUCSSIONS: (Additional information to consider)
Missouri performs poorly on the Robert Wood Johnson End-of-Life Report Card
(Pain and Policy Studies Group, 2003)
“B”: State Pain Policies that support palliative care
“C”: % of nursing home residents with persistent pain in 1999
“C”: End of Life Services
“D”: Hospice stays 2000
Per cent of people who died at home
Hospitals reporting hospice services 2000.
“E”: Percent of hospitals reporting palliative care programs in 2000
“E”: Percent of nurses certified in palliative care 2000
Projected shortage of 200,000 physicians by 2020 (Reuters, 2004). Implications for adequate palliative care and pain management especially in rural and underserved areas if APRN’s do not have prescriptive privileges.
2020 2.5 million older adults will die each year and 40% of the deaths will occur in nursing homes that have a low ratio of physicians and nurses to residents (Valente, 2004). Implications: Growing unmet needs in end-of-life care for nursing home residents.
80% of elderly have chronic pain and 66% have pain in last month of life
(Valente, 2004). Implications: Growing need for service providers.

APRN’s ARE WELL SUITED TO MEET THESE NEEDS:
· Best Practice Guidelines for pain management include: Assessment, Documentation, Relationship and Interaction with the Provider, and Education that are all within APRN scope of practice (American Pain Society, 1995; Stark, Sherwood & Adams-McNeill, 2000).
· Advanced Practice Registered Nurses play a critical role in increasing access to services and improving the quality of care for patients with advanced chronic illness. A demonstrated and cost effective response to the health care crisis is better utilization of APRN’s. This group strongly advocates for full scope of practice for APRN’s.
(American Nursing Leaders, 2001).

References:
American Nursing Leaders. (2001). Advance practice nurses role in palliative care. Position statement from Promoting Excellence in End-of-Life care conference.
American Pain Society. (1995) Healthcare policy statement. http://www.ampainsoc.org/advocacy/polstat.htm
ONS. (2003). The role of the advance practice nurse in oncology care. Oncology Nursing Forum, 30(4).
Pain and Policies Studies Group. (2004). Achieving balance in state pain policy: A progress report care. http://www.medsch.wisc.edu/painpolicy
Pearson, L. (2004). Sixteenth annual legislative update: How each state stands on legislative issues affecting advanced nursing practice. The Nurse Practitioner. 29(1). 26-31.
Starck, P., Sherwood, G., & Adams-McNeil, J. (2000). Pain management outcomes: Issues for advanced practice nurses. The Internet Journal of Advanced Nursing Practice. 4(1) 1-10.
http://www.ispub.com/ostia/index.php?sml
Tumolo, J. (2003). And then there were six: Fewer states withhold CS authority from NPs. Advance Newsmagazine for Nurse Practitioners.