Texas Register, Volume 38, Number 49, Pages 8721-8970, December 6, 2013 Page: 8,750
8721-8970 p. ; 28 cm.View a full description of this periodical.
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(2) Failure to notify the Board [board] of a current mailing
address will not absolve the licensee from audit requirements.
(3) - (4) (No change.)
216.10. Appeals.
(a) (No change.)
(b) The Board [beard] or its designee shall conduct a review
in which the appellant may appear in person to present reasons why the
audit decision should be set aside or modified.
(c) The decision of the Board [beard] after the appeal shall be
considered final and binding.
216.11. Consequences of Non-Compliance.
Failure to comply with the Board's [beard's] continuing competency
requirements will result in the denial of renewal.
The agency certifies that legal counsel has reviewed the pro-
posal and found it to be within the state agency's legal authority
to adopt.
Filed with the Office of the Secretary of State on November 22,
2013.
TRD-201305407
Jena Abel
Assistant General Counsel
Texas Board of Nursing
Earliest possible date of adoption: January 5, 2014
For further information, please call: (512) 305-6822
CHAPTER 228. PAIN MANAGEMENT
22 TAC 228.1
Introduction. The Texas Board of Nursing (Board) proposes new
Chapter 228, 228.1, concerning Pain Management. The new
section is proposed under the authority of the Occupations Code
157.0511(b), 168.002, 168.201, 301.002, 301.151, 301.452,
301.453, and 301.4531, as well as the general authority of Sen-
ate Bill (SB) 406 (83rd Legislature, Regular Session, effective
November 1, 2013); House Bill (HB) 1803 (83rd Legislature,
Regular Session, effective January 1, 2014); and SB 1643 (83rd
Legislature, Regular Session, effective September 1, 2013), and
prescribes the minimum standards of nursing practice for an
advanced practice registered nurse (APRN) who provides pain
management services.
Many APRNs practice in pain management settings and/or
provide pain management services. Under the Board's current
rules, these APRNs are required to comply with the minimum
standards of nursing practice set forth in existing 22 TAC
217.11 (relating to Standards of Nursing Practice) and the
requirements set forth in 22 TAC Chapter 221 (relating to
Advanced Practice Nurses) and 22 TAC Chapter 222 (relating
to Advanced Practice Registered Nurses with Prescriptive
Authority). While these rules contain minimum requirements for
patient assessment, documentation, and diagnosing and pre-
scribing under appropriate physician delegation, the Board has
determined that additional guidance is needed for APRNs who
practice in the area of pain management. This determination is
based, in part, on reports of increased "pill mill" activity in Texas
clinics staffed by APRNs.As part of treating pain, pain management clinics frequently dis-
pense prescription drugs, such as opioids, and other highly ad-
dictive medications. These types of clinics are sometimes as-
sociated with "pill mill" activity. "Pill mills" are usually cloaked
under the illusion of a legitimate medical clinic. However, unlike
legitimate facilities whose purpose is to provide medical services
consistent with the standard of care, "pill mills" distribute large
quantities of controlled substances and medications, without re-
gard to medical necessity or therapeutic benefit, in exchange for
monetary incentives. As a result, "pill mills" have been linked to
increased risks of prescription drug abuse and overdoses. Be-
cause APRNs may diagnose and prescribe medications under
the delegated authority of a physician, APRNs have been linked
to prescribing practices that are consistent with "pill mill" activity.
Further, APRNs have also been employed at pain management
clinics that have been closed by law enforcement agencies due
to their "pill mill" activities.
The Texas Legislature first introduced legislation in 2009 (Senate
Bill 911, 83rd Legislature, Regular Session) affecting the regis-
tration, inspection, and monitoring of pain management clinics
in Texas. Since then, the Legislature has continued to monitor
"pill mill" activity. In the 83rd Legislature, Regular Session, the
Legislature passed HB 1803, SB 406, and SB 1643 all intended
to support the continued regulation of pain management clinics,
services, and providers in this state.
The Board recognizes that the treatment of pain is complex. It
often involves complex treatment plans and layers of healthcare
providers working together to reduce a patient's suffering and
improve his/her quality of life. The Board also recognizes that
the legitimate treatment of pain may also involve the use of pre-
scription medications, including opioids. The proposed new rule
is not intended to prevent APRNs from providing legitimate pain
management services to patients nor is it intended to impede
an APRN's existing pain management practice. Rather, the pro-
posed rule is intended to provide additional guidance to APRNs
who provide pain management services. The proposed new rule
succinctly sets forth the minimum standards of practice that an
APRN must adhere to when providing pain management ser-
vices. These standards are intended to protect patients and
the public from inappropriate, non-therapeutic, non evidenced
based, and/or dangerous treatment practices.
Stakeholder Collaboration
The Board's Advanced Practice Nursing Advisory Committee
(Committee) met on May 31, 2013; July 1, 2013; and September
16, 2013, to discuss new rules related to pain management. Af-
ter its discussions, the Committee voted to recommend the pro-
posed new rule to the Board for adoption. The Board considered
the proposed new rule, the Committee's recommendations, and
Staffs recommendations at its October 2013 meeting. Follow-
ing discussion and deliberation, the Board voted to approve the
publication of the proposed new section in the Texas Register.
Section by section overview.
Proposed new subsection (a) sets forth the definitions to be used
within the new chapter.
Proposed new subsection (b) identifies the purpose of the new
chapter and reiterates the Board's expectations regarding the
provision of pain management services. Because the treatment
of pain can be highly individualized and complex, a reasonably
detailed and documented plan of care is necessary to ensure
that a patient's treatment is appropriately monitored. Further, al-
though the Board recognizes that the prescription of medications38 TexReg 8750 December 6, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 49, Pages 8721-8970, December 6, 2013, periodical, December 6, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth379983/m1/30/: accessed April 24, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.