New rules from the Centers for Medicare and Medicaid Services (CMS) will require nursing home care providers to assess the use of opioids by residents and provide a warning to residents when they have used an opioid within the past six months.
The CMS announcement, which is expected to be announced Wednesday, also mandates that the provider assess whether an opioid is being used by the resident or other nursing home visitors, and to ensure that the resident is not receiving opioids at home.
The new rules, which were developed after the CDC and other government health agencies identified a significant rise in the use and abuse of prescription opioids by patients in nursing homes, come as some states have implemented new laws that limit the amount of opioids that can be given to residents.
States and counties in Pennsylvania, for instance, have banned the use or distribution of OxyContin, a powerful painkiller that can cause respiratory depression and respiratory depression-like symptoms.
New York, Illinois, Indiana, Minnesota, New Jersey, Ohio, Wisconsin and West Virginia have also banned the drug.
The rules will apply to nursing homes that are certified as medically appropriate by the American Academy of Hospitals and Surgeons (AAHOS), the governing body for the nursing home industry.
In addition, the CMS rules will require that the nursing homes provide a written notification to the resident that the use, distribution or possession of opioids is not permitted.
They will also require that they obtain written consent from the resident for the use.
Under the new rules:The rules require a written assessment from a licensed nurse who has experience caring for people with chronic conditions, such as Alzheimer’s or multiple sclerosis, or who has supervised a resident to determine whether an individual has ever used an overdose of an opioid, whether the individual is receiving opioids, and whether the resident has opioid-related health conditions.
They also require a mental health assessment for the resident and any other nursing homes visitors.
The assessment should include a diagnosis of opioid-use disorder and provide an indication of how much the resident should be monitored and treated.
The nurse also will determine whether the patient has had at least three opioid-dependent episodes within the last six months, or whether the person has recently been using opioids.
If the assessment indicates that the person is at high risk of developing opioid-respiratory depression or respiratory depression, the nurse will refer the resident to a qualified healthcare professional who can prescribe opioids to manage that risk.
The regulations also require the nursing staff to provide the resident with a written written notice that the facility will not provide opioids to residents and other nursing facilities visitors if the person receiving the opioids has opioid dependence, opioid addiction or is a chronic user.
The nursing staff will also need to notify the resident if the resident becomes dependent on opioids or has opioid addiction and provide the patient with a withdrawal plan.
The guidelines also require an independent evaluation of the facility’s plan for managing the risk of opioid dependence and opioid addiction.
The evaluation should include an assessment of the patient’s risk for relapse, withdrawal symptoms, hospitalization and long-term health consequences.
The nursing home will be required to provide a copy of the report to the state or local health department.
The information will be shared with the public, including the public health officials.
The U.S. Food and Drug Administration (FDA) has already released a summary of the research it reviewed on opioids in nursing home patients.
The FDA found that while some nursing home physicians were prescribing opioids, other physicians and residents were using the medications in an illegal way.
The FDA also said that, at least among patients receiving opioids in the home, the number of opioid prescriptions prescribed to residents was low.
In a survey of nearly 1,000 nursing home nurses, the FDA found only 10 percent of those who had received opioid prescriptions in the last 12 months were prescribed opioids for pain control.
The findings prompted the American College of Physicians to release a statement last month calling for the new regulations to be rolled out immediately, as long as the rules are implemented.