Annotated Bibliography 075961

Annotated Bibliography

This assignment involves analyzing a set of scholarly articles related to educational reform, instructional leadership, school culture, standardized testing, and leadership sustainability, and then applying this understanding to a clinical scenario involving prescribing controlled substances in a restricted state, specifically California.

Cleaned Instructions: Write approximately 1000 words (minimum 250, maximum 1000), integrating insights from the annotated bibliography to demonstrate knowledge of educational reform and leadership, and then apply these principles to a clinical case. The paper should include analysis of current concerns about her medication regimen, alternative strategies, screening protocols, ethical considerations, sample pain contract, steps for safe prescribing including registry checks, legal limitations on refills, prescribing forms, reporting requirements, and protocol components for controlled substance prescribing. Use credible sources and cite appropriately in APA format.

Paper For Above instruction

The comprehensive approach to educational reform, as elucidated in the annotated bibliography, underscores the importance of organizational management, cultural transformation, and sustained leadership in improving school outcomes (Balfanz et al., 2018; Kanaany et al., 2021; Vujić et al., 2019). These principles serve as an important analogy for clinical practice, especially in managing complex pharmacologic regimens and ensuring ethical, legal, and safety standards in prescribing controlled substances.

Turning to the clinical scenario involving ML, a 54-year-old Hispanic female with chronic shoulder and back pain, the initial concern focuses on her current medication regimen, which includes opioids (Norco), gabapentin, benzodiazepines (diazepam), antihypertensives, statins, and smoking habits. Her usage of multiple CNS depressants raises red flags, notably the risk of respiratory depression, potential for misuse, and interactions, especially considering her ongoing use of alcohol during social occasions. Polypharmacy, especially involving opioids and benzodiazepines, warrants careful evaluation and warrants consideration of safer alternatives to mitigate overdose risk and enhance her pain management.

One could debate the appropriateness of continuing long-term opioid therapy, given her history and social context (Dowell, Haegerich & Chou, 2016). Alternative approaches include referral to pain management specialists for multimodal pain strategies, non-pharmacological interventions such as physical therapy, acupuncture, or cognitive behavioral therapy, and further assessment of her pain’s psychosocial dimensions. Additionally, considering her living situation and caregiving role, strategies for safe medication use and minimizing the risk of misuse are crucial.

Screenings such as urine drug testing, mental health assessment for substance misuse or depression, and evaluation for alcohol use should be routinely implemented (Korthuis et al., 2017). Furthermore, her smoking history necessitates counseling and resources for cessation, as smoking can exacerbate pain and impair healing (Lien et al., 2018). Pharmacogenetic testing may be considered to optimize her medication choices, although access could be limited.

Ethically, I must adhere to beneficence and non-maleficence by ensuring her safety, balancing pain relief with potential harm, and respecting her autonomy through shared decision-making. Legally, prescribers are accountable for preventing diversion and misuse, adhering to state-specific regulations, including monitoring and documentation.

A sample pain management agreement tailored for her includes provisions such as medication adherence, no sharing medications, regular follow-up appointments, and consent to urine drug screening (CDC, 2020). An example can be downloaded from the CDC’s opioid prescribing guidelines website and tailored to align with her specific needs and risks.

To ensure safe prescribing, I would verify her medication history via the California Prescription Drug Monitoring Program (PDMP) prior to issuing or refilling any controlled substances (California DOJ, 2022). This step helps identify potential misuse or doctor shopping. In states like California, refills of Schedule III-V medications are generally permitted for up to six months, with a limit of five refills, but regulations should be confirmed as evolving (California Business and Professions Code, 2022). For Schedule II drugs, prescriptions must be issued with an original, signed paper or electronic prescription limited to a 30-day supply with no refills, except under specific exceptions.

Controlled substances prescriptions—particularly opioids—must be issued on e-prescription platforms or paper templates compliant with state laws. Prescriptions should include patient identifiers, medication name, dosage, route, quantity, directions, prescriber’s signature or electronic authentication, and DEA number. When making these prescriptions, I would report the details to the California PDMP immediately after issuance to ensure documentation and facilitate monitoring by other healthcare providers (California PDMP, 2022).

If I choose to continue her current list but avoid abrupt discontinuation, it is crucial to follow California law, which restricts initial opioid prescriptions to a 7-day supply for acute pain, with extended methods requiring detailed documentation and signed agreements (California Business and Professions Code, 2022).

Post-prescription, I or my staff would log into the California PDMP and record the medication details within 24 hours, making the information accessible to other prescribers and pharmacists to prevent misuse. This is a legal requirement designed to improve medication safety and coordination of care.

Regarding protocols for prescribing schedule II and III substances, as an APRN in a restricted state, I must operate under a standardized, written protocol approved by a physician or health authority. Such a protocol should include: 1) specific patient eligibility criteria, 2) assessment procedures, 3) informed consent, 4) documentation requirements, 5) ongoing monitoring measures, 6) safety net plans for adverse effects or misuse, 7) steps for discontinuation or tapering, and 8) reporting obligations. Adherence to these components ensures compliance and promotes safe, ethical prescribing practices (American Psychiatric Association, 2020).

In summary, managing ML’s pain effectively requires balancing her need for relief with a cautious approach to prescribing, frequent monitoring, and adherence to legal requirements—all grounded in ethical principles of beneficence, non-maleficence, autonomy, and justice. Through comprehensive assessment and shared decision-making, I aim to provide safe, patient-centered care while preventing harm and ensuring compliance with state and federal regulations.

References

  • Centers for Disease Control and Prevention (CDC). (2020). CDC Guideline for Prescribing Opioids for Pain. https://www.cdc.gov/drugsafe/pdf/hcp/clinical-decision-making-guideline.pdf
  • California Business and Professions Code, § 4000 et seq. (2022).
  • California Department of Justice. (2022). Prescription Drug Monitoring Program (PDMP). https://oag.ca.gov/pdmp
  • Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR. Recommendations and Reports, 65(1), 1–49.
  • Korthuis, P. T., et al. (2017). Primary care management of substance use disorders. JAMA, 317(18), 1865–1875.
  • Lieberman, P., et al. (2018). Smoking and pain: A review. Pain, 159(5), 819–826.
  • National Conference of State Legislatures (NCSL). (2021). State limitations on opioid prescriptions. https://www.ncsl.org/research/health/state-limitation-on-opioid-prescriptions.aspx
  • American Psychiatric Association. (2020). Practice guideline for the assessment and treatment of patients with suicidal behaviors. https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines
  • Vujić, D., et al. (2019). The role of the leader in empowering and supporting employees towards sustainable development. Vojno delo, 71(5), 123–132.
  • Kim, C., et al. (2019). Strategies for safe opioid prescribing. Journal of Clinical Pharmacy and Therapeutics, 44(3), 330–337.

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