DEA rules and pain control in long-term care. A Drug Enforcement Administration (DEA) statement of policy released in October 2010, Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies, was widely reported to include a policy change that would speed nurses' ability to treat pain in long-term care facilities.
Careful reading of the document, however, reveals that it's primarily a restatement of existing policy. "DEA regulations on the role of authorized agents in communicating controlled substance prescriptions to pharmacies generally have not changed," it states.
Rather, the statement merely outlines the means for establishing a valid agency relationship and explains the roles that designated agents are permitted to play regardless of setting. Nurses in long-term care facilities are now clearly named as such agents, which should prevent confusion over who can communicate controlled substance prescriptions to pharmacies, but whether this will actually have the desired outcome is unclear.
As the topic of health care delivery heats up this year, keep an eye on this particular issue as nurses, pharmacists, and leaders in long-term care encourage further changes to support better pain relief for patients in long-term care facilities.
Arthritis prevalence is expected to increase significantly. The Centers for Disease Control and Prevention analyzed National Health Interview Survey data from 2007 through 2009 on adults at least 18 years of age and determined that arthritis and its associated limitations on physical activity "represent a major public health problem in the United States."
One in five respondents reported having the disease as diagnosed by a physician, which, extrapolated to the U.S. population, translates into 49.9 million adults with arthritis (and 21.1 million with "arthritis-attributable activity limitation"). The results of the self-reported annual survey were published in the October 8 Morbidity and Mortality Weekly Report.
Arthritis was defined as "some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia." Aging and obesity were tagged as the primary contributing factors, with obesity in particular contributing to osteoarthritis of the knee.
The report calls for implementation of obesity-prevention strategies and local community-based efforts to increase physical activity programs and education courses on self-care. Read the report at http://bit.ly/bxoOva, and watch for forthcoming articles on arthritis in AJN this year.
Keep an eye on REMS requirements. The Food and Drug Administration (FDA) is authorized to require Risk Evaluation and Mitigation Strategies (REMS) if it determines that they're needed to ensure that the benefits of a drug outweigh the risks. Such strategies can include (among other things) medication guides, "Dear Health Care Provider" letters, readjudication of studies, and clinician or pharmacist training.
Risk–benefit information is particularly crucial when patients are taking drugs for prevention. For example, in response to data showing that atypical femoral fractures may occur in patients using bisphosphonates for longer than five years, the FDA recently required labeling changes for all such agents used to treat osteoporosis. FDA letters to manufacturers included a notice that REMS are now required for these agents, and clinicians were advised to interrupt therapy until a risk–benefit assessment for the patient is performed.
Likewise, REMS were approved in February 2010 for erythropoiesis-stimulating agents, which may increase tumor growth and shorten survival in patients with cancer. The drugs have been used in oncology to treat anemia associated with chemotherapy, reducing the likelihood that transfusion will be needed. The FDA's growing list of required REMS can be monitored at http://bit.ly/d1F587.