WAC 246-840-487. Consultation — Exemptions for exigent and special circumstances

An advanced registered nurse practitioner is not required to consult with a pain management specialist as defined in WAC 246-840-493 when the advanced registered nurse practitioner has documented adherence to all standards of practice as defined in WAC 246-840-460 through 246-840-493 , and when any one or more of the following conditions apply: (1) The patient is following a tapering schedule; (2) The patient requires treatment for acute pain, which may or may not include hospitalization, requiring a temporary escalation in opioid dosage with expected return to their baseline dosage level or below; (3) The advanced registered nurse practitioner documents reasonable attempts to obtain a consultation with a pain management specialist and the circumstances justifying prescribing above one hundred twenty milligrams morphine equivalency dosage (MED) per day without first obtaining a consultation; or (4) The advanced registered nurse practitioner documents the patient's pain and function is stable, and the patient is on a nonescalating dosage of opioids.