Power Point 1
Control Substance Law That Change Status for Nurse Practitioners in Florida in 2017
Effectiveness of a health care system largely depends on collaboration and coordination that health care workers undertake to achieve better patient outcomes. Over the past few years significant efforts have been undertaken to protect and improve the scope of nursing practice. Nurses are extensively involved in provision of patient care and improvement of health care systems around the globe. However, to advance the nursing scope of practice, various laws and regulations have to be implemented within the health care system to ensure that such advancement may not result into health care deficiencies and poor patient outcomes. Due to the negative mental and health effects associated with control substances such as opioids, depressants and hallucinogens, state laws are changing the status of nursing practice to decrease the access to such drugs. In its efforts to decrease the mental and health effects of control substances, the state of Florida has focused on implementing control substance laws that have resulted in a number of health outcomes issues and changed the status of nursing practice within the state upon their implementation in 2017.
Recent Health Care Legislature on Control Substance in Florida
The importance of nurses for health care systems cannot be doubted. Therefore, it is essential that nurses practice provision of patient care to the full extent of their education and abilities. By advancing the scope of practice for nurses, the state of Florida has achieved significant health care benefits and the delivery of efficient, safe and quality patient care (Brokaw, 2016). In 2017, the Florida Board of Nursing made important updates regarding the implementation of prescription of controlled substances. According to the legislature, both Physician Assistants (PAs) and Advanced Registered Nurse Practitioners (ARNPs) were legally allowed to prescribe controlled substances as from January 1, 2017 (Florida Board of Nursing, 2016). Since such medical practitioners did not have a legal obligation to prescribe controlled substances, it is evident that Florida expanded the scope of practice of ARNPs in health care (Florida Board of Nursing, 2016). Consequently, enabling ARNPs to prescribe or dispense controlled substances was essential in decreasing medical workload experienced by senior physicians, who had been undertaking such medical role before 2017.
Despite the fact that controlled substance law enacted in Florida was aimed at advancing the scope of practice of ARNPs, it was associated with limitations on the education and skills of the ARNPs. Other than legally allowing PAs and ARNPs to prescribe and dispense controlled substances, the law required that such medical practitioners designate themselves as prescribers of such medications within their profiles (Florida Board of Nursing, 2016). However, prior to undertaking such advancement in the scope of nursing practice, PAs and ARNPs were required to complete at least three hours training on controlled substance prescription that would ensure that they safely and effectively conduct such medical role (Florida Board of Nursing, 2016). On that account, it would be possible to minimize the risk of medical errors associated with the prescription of controlled substances by ARNPs.
Literature Review
Controlled substance medications are effective in facilitating better patient outcomes. However, empowering ARNPs to prescribe controlled substance medications in Florida can mainly be attributed to the negative health effects of such medications. According to Quinn et al., (2017), controlled substance medications can treat moderate to severe pain, sleeping disorders and seizures among other conditions. Nevertheless, such medications can lead to memory loss, anxiety, drowsiness, coma, suicidal thoughts, death and difficulty in breathing (Quinn et al., 2017). Since such health effects are costly to health care organizations and negatively impact the health of the patients, proper control of controlled substance medications is essential (Quinn et al., 2017). The creation of balance between the health benefits and effects of controlled substance medications mainly relies on whether they are properly prescribed and taken (Quinn et al., 2017). Therefore, by legally allowing ARNPs to prescribe and dispense controlled substance medications, it would be possible to avoid the negative health effects of such medications caused due to incorrect prescription, overdose or under dose.
Medication errors have undoubtedly been the greatest hindrance to provision of quality and safe patient care. Vadivelu et al., (2018) claim that medication errors have resulted in an increase in hospital readmissions, which negatively impacts the cost effectiveness and operational efficiency of health care facilities. For that reason, inclusion of ARNPs in the prescription of controlled substance medications in Florida is an effective strategy in reducing hospital readmissions caused by medication errors (Florida Board of Nursing, 2016). To reduce medication errors, health care workers must exercise proper drug prescriptions by considering the ‘five rights’ which includes, right dose, right route, right drug, right patient and right time (Vadivelu et al., 2018). Since controlled substance medications may result into negative mental and physical health of a patient in case of violation of any of the ‘five rights’, they must be properly prescribed (Vadivelu et al., 2018). For that reason, education of Florida ARNPs on the prescription of controlled substance medications is aimed at preventing medication errors.
Coordination of patient care within the health care facility is essential in improving patient experience and achieving the desired health outcomes of a specific treatment plan. Salmond & Echevarria (2017) agree that to achieve a proper coordination of care, the roles of nurses in the provision of patient care must constantly change. Therefore, advancing the scope of nursing practice of Florida ARNPs is essential in improving patient outcomes by enhancing the coordination of patient care within the state (Salmond & Echevarria, 2017). However, to appropriately realize the importance of their advancement in medical practice, nurses must effectively communicate with other health care practitioners, such as physicians and focus on a patient centered care (Salmond & Echevarria, 2017). For that reason, nurses must consider advancing their scope of practice as an opportunity to decrease the medical workload experienced by other health care staff and a way of increasing their involvement in provision of quality and safe patient care (Salmond & Echevarria, 2017). Since ARNPs are actively involved in coordination of patient care, legally allowing them to conduct prescription of controlled substances is aimed at enhancing delivery of care to achieve the desired patient health outcomes.
One of the most common reasons behind seeking of medical care by patients is to achieve pain relief. However, despite the fact that there are many categories of pain relief medications, controlled substance medications are considered highly effective in relieving pain, thereby they are frequently prescribed to the patients experiencing various health related challenges such as acute, cancer, neurological and end-of-life pain (Scully et al., 2018). The prescription of controlled substance medications depends on whether a medical practitioner can effectively distinguish between the legitimate prescriptions of such medications and prescriptions for illegitimate and recreational purposes (Ballantyne et al., 2017). Determining the difference between a legitimate prescription of controlled substance medication and an illegitimate one depends on the ability of medical practitioners to understand the signs and symptoms and treatment of both acute and chronic pain using such medications (Ballantyne et al., 2017). For the past decades, the Florida Board of Nursing has been focusing on improving the provision of care by ARNPs by providing the necessary medical education needed to conduct diagnosis and treatment of acute and chronic pain among patients (Florida Board of Nursing, 2016). Therefore, by legally allowing ARNPs to prescribe controlled substance medications, the board has entrusted these health care practitioners with the ability to distinguish the difference between a legitimate and illegitimate prescription of such medications.
Statistical Data Related to the Issue
Since the beginning of the current century, the negative effects of controlled substance medications abuse have significantly affected the health care system of Florida. The opioid epidemic in Florida that occurred between 2000 and 2017 is considered the main reason behind introduction of the legalization of ARNPs in prescribing controlled substance medications (Handberg, 2020). During the seventeen year period, there was a substantial increase in the number of deaths caused as a result of opioid abuse within the state, particularly among the younger population. In the year 2000, the number of people, who died due to the use of opioids in Florida was approximately 350 (Handberg, 2020). However, within just a ten year period, the deaths caused by the use of opioids, the most abused controlled substance medications within the state, rose to over 2000 people (Handberg, 2020). Therefore, despite the fact that there was a slight decline in the number of deaths caused by opioid pills, there was need to improve the prescription and dispensation procedures for these medications.
Despite the fact that Florida enforced a statewide crackdown on the illegal use of opioids in 2011, it was evident that stiffer legislative changes were necessary to prevent further deaths caused by abuse of medications. By 2013, a total of 5,400 people were diagnosed mentally disabled as a result of the use of opioid drugs abuse (Handberg, 2020). More than 75% of such people were mainly youths aged between 15 and 35, who had abused heroine and morphine (Handberg, 2020). Consequently, the Florida Department of Law Enforcement (FDLE) had to conduct law enforcement efforts to ensure proper control in the use of controlled substance medications (Handberg, 2020). The FDLE identified that most cases of controlled substance abuse was as a result of the need to manage both physical and emotional pain (Handberg, 2020). Therefore, over 370 clinics that were providing illegal controlled substance medication prescription within the state were closed down between 2013 and 2017 (Handberg, 2020). Furthermore, during the same period, 800,000 controlled substance pills were seized by the law enforcement agency with the aim of decreasing the number of death and disabilities caused due to controlled substance medication abuse (Handberg, 20200. The FDLE also made over 3000 arrests related to the illegal use of controlled substance medications with over 80% of such arrests involving youths (Handberg, 2020). Therefore, such law enforcement efforts led to a significant decline in the number of deaths and disabilities caused due to controlled substance medication abuse.
Population Impacted
The use of opioids, such as heroine and morphine is mainly reported to be used for recreational purposes by the younger population. However, the inclusion of ARNPs in prescribing and dispensing controlled substance medications has mainly affected chronic pain patients (Ballantyne, 2017). For the past twenty years, there has been an increase in the number of patients with diseases that lead to severe pain. In Florida, a 21% increase in the number of patients diagnosed with conditions, such as cancer, arthritis and multiple sclerosis has been recorded during the past decade (Handberg, 2020). The main health effect associated with such diseases is chronic pain that should be effectively managed through prescribed drugs to enhance the quality of patient lives (Ballantyne, 2017). The use of controlled substance medications in management of chronic pain has been considered more effective than other pain relieving strategies (Ballantyne, 2017). Consequently, by legally allowing ARNPs to conduct the prescription of controlled substance medications, chronic pain patients have been both positively and negatively impacted by such law.
A significant number of drug overdose deaths experienced in Florida and the United States can mainly be attributed to prescription of opioids. While cases of overdose of controlled substance medications are mainly result of patients or patients’ families administering the druds, physicians, who prescribe such medications have been also found at fault (Ballantyne, 2017). Consequently, the Florida state government has been imposing strict measures in an attempt to reduce the use of controlled substance medications for the purpose of pain management (Florida Board of Nursing, 2016). The legislature aimed at restricting the use of controlled substance medications for the purpose of chronic pain management has led to health care workers fearing the repercussions of poorly prescribing such medications (Ballantyne, 2017). Consequently, by ensuring that Florida ARNPs undertake education on prescribing controlled substance medications, the state government of Florida has ensured that chronic pain patients do not experience over dosage of such medications, hence benefit from improved care outcomes.
Health Outcome of the Issue and the Legislature
Introduction of legislations on controlled substance medications has mainly been as a result of the health care costs that states experience due to the abuse of such medications. According to the Food and Drug Administration (FDA), the overdose of drugs has led to more deaths that exceeds those related to motor-vehicles accidents in over 30 states within the United States during the past five years (Handberg, 2020). In this regard, Florida is one of the states that has been experiencing a higher number of deaths due to overdose of drugs with controlled substance medications such as opioids being the majorly overdosed medications (Handberg, 2020). The misuse and prescription of drugs costs the United States an annual estimated loss of $53.4 billion with over half of such loss being experienced by the health care system (Handberg, 2020). As a result, since the overdose of control substance medications negatively affects the operational efficiency and cost effectiveness of the states’ health care system, it has been important to adopt proper prescription as a good medical practice.
Due to the effectiveness of controlled substance medications in the management of pain among patients, the main health outcome of the issue is an improvement in the quality of life of most chronic pain patients. There is no doubt that pain is subjective in that it must be addressed from the patient’s point of view (Scully et al., 2018). While there was an insufficient medical commitment to manage chronic pain during the past century, the use of controlled substance medications has led to most chronic pain patients being treated (Scully et al., 2018). The prescription of controlled substance medications, such as opioids has become an efficient method in treating pain among patients in both palliative and non-palliative care settings (Scully et al., 2018). Therefore, by imposing legislations aimed at controlling the use of controlled substance medications through prescription, it has been possible for chronic pain patients to achieve a better quality of life.
Despite the fact that there have been recorded better patient outcomes, as a result of the use of controlled substance medications, an improper prescription has led to numerous hospital readmissions. For that reason, states have been experiencing high health care costs as a result of mental and physical health challenges caused by abuse of controlled substance medications that resulted in hospital readmissions (Handberg, 2020). By legally allowing ARNPs to prescribe controlled substance medications in 2017, Florida has been able to enhance the quality of care provided to chronic pain patients. Since ARNPs conduct the coordination of care provision to chronic pain patients, they have been able to understand the treatment and care needs of such patients (Brokaw, 2016). Like any clinical therapy, the use of controlled substance medications to manage pain in the patients, depends on a number of factors, such as the patient’s health condition and the severity of the complication (Scully et al., 2018). As a result, some patients positively respond to such medications, while others do not (Scully et al., 2018). By enabling ARNPs to prescribe controlled substance medications, Florida has been able to achieve a patient centered care in the management of pain among the patients admitted in the state health facilities (Handberg, 2020). For Therefore, the legislation enabled provision of a compassionate, yet safe and effective management of care among chronic pain patients.
Nursing Role in Passing the Legislature
An effective healthcare system is periodically redesigned for the purpose of meeting the needs of both patients and health care professionals. Nursing is, undoubtedly, the largest medical profession in the world with over four million nurses serving in the United States health care system alone (Brokaw, 2016). Since there are significantly more nurses than any other medical professionals, nursing is instrumental in redesigning health care systems by enabling the passing of health care legislations (Brokaw, 2016). In order to achieve enactment of the legislation on the prescription of controlled substance medications by ARNPs in Florida, nursing played a role of identifying the effects of abuse of such medications (Brokaw, 2016). Nurses provide patient care through an interdisciplinary teamwork, thereby, they are able to determine the health effects of certain treatment and patient care plans (Brokaw, 2016). For that reason, ARNPs in Florida were able to recognize the side effects of overdose of various controlled substance medications, which provided sufficient grounds for passing of the legislation. By enabling health policy makers to determine the effects of an overdose of various controlled substance medications, it was important to empower the ARNPs to prescribe such medications, since they were cognizant of the dosage threshold needed to achieve a better patient outcome.
Conclusion
The passing of controlled substance medications legislations in Florida has not only led to prevention of negative health effects caused by abuse of such drugs, but promoted expansion of the scope of nursing practice within the state. Despite the fact that controlled substance medications are important in improving the health outcomes of certain groups of patients, they are associated with both mental and physical health effects that are costly to health care systems. Since there has been an increase in the number of deaths and disabilities caused by the abuse of controlled substance medications in Florida, it was important to ensure that such medications are properly prescribed. Due to the fact that ARNPs are skilled in formulating treatment and care plans, it was essential to actively involve them in the passing of the legislation to improve the quality of patient care especially for chronic pain patients, while decreasing health care costs.
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