Half a Hold…

1. Half a Hold… Is better than none at all

2. M 0.5 Holds SB-18-207 was approved and will go into effect this month.  Allows for a new process (the M-0.5 or Transportation Hold) which is valid for 6 hours.  A Law Enforcement Officer can place this Hold for the purposes of transporting an individual to an ER or other mental health specific evaluator, who can then make the assessment for whether the person meets criteria for a true M-1 Mental Health Hold.  

3. M 0.5 Holds Hopefully will get residents to an appropriate level of care if there is a question as to their psychiatric status and endangerment toward others by using this 6 hour hold to allow for transport for a more thorough psychiatric assessment.  A completed M-0.5 form is required in the clinical record.  Some counties have provided education to Law Enforcement while others have not.

5. Sb 18-22 Clinical practice for opioid prescribing Limits the number of opioid pills a healthcare provider can prescribe. Prescriber must limit patient’s initial prescription of an opioid to a 7 supply if they have not written an opioid prescription for the patient in the last 12 months. The prescriber may exercise discretion in including a second fill for a 7 supply.

6. Sb 18-22 Clinical practice for opioid prescribing The limits do not apply, if, in the judgment of the prescriber, the patient: • Has chronic pain typically lasting >90 days or past the time of normal healing, as determined by prescriber, or following transfer of care from another prescriber who prescribed an opioid to the patient; • Has a diagnosis of cancer / is experiencing cancer related pain; or • Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days.

7. Sb 18-22 Clinical practice for opioid prescribing After first prescription, prescriber is required to check the PDMP database before prescribing any additional opioids. Failure to check PDMP is unprofessional conduct if the prescriber repeatedly fails to comply. The second fill requirement to check PDMP does not apply when a patient: • Is receiving the opioid in a hospital, SNF, residential or correctional facility; • Has been diagnosed with cancer and is experiencing cancer related pain; or • Is undergoing palliative or hospice care; • Is experiencing post-surgical pain, that, because of the nature of the procedure, is expected to last more than 14 days;

8. TB Screening & Surveillance guidance These recommendations describe TB control activities appropriate for nursing homes and other facilities providing long-term care. Recommendations are intended for use by staff and administrators of these facilities, consultants to these facilities, and regulatory and licensing bodies. 

9. TB Screening & Surveillance guidance Any person with symptoms consistent with TB, an abnormal CXR, or positive sputum smears or cultures will not be admitted to a facility until a medical provider deems that person non-infectious. If TB is suspected in a resident or healthcare worker, it must be reported to the county and/or state health department within 24 hours.  For reporting or consultation call:  • Working hours: 1-303-692-2656  • After hours: 1-303-692-2700  TB testing is a condition of employment, prior to contact with patients, as well as with admission to a facility. 

10. New admissions All new admissions, except those with a documented severe hypersensitivity reaction to PPD (e.g., ulceration or necrosis) must receive a 2 tuberculin skin test (TST). If the first TST is negative, a second test must be placed 1–3 weeks after the first. If a documented negative TST result in the past 12 months is provided, it will be considered the first step, and only one step will be given. If documentation of a negative 2 test done in Colorado in the previous 6 months is provided, it will be considered adequate.

11. Healthcare workers Baseline TB screening prior to first day of work is required for all healthcare workers, consisting of an evaluation to determine if there are current symptoms of active TB and testing by a two-step TST. If there is a documented negative TST within 12 months of hire that is provided to the hiring agent, only a one-step TST test is required.  Those with a documented severe hypersensitivity to PPD shall receive an Interferon Gamma Release Assay (IGRA), which is a QuantiFERON or T-Spot blood test, rather than a TST. Persons with a history of BCG vaccination should have an IGRA rather than TST. 

12. Annual screening for Healthcare workers Annual HCW TB screening shall be completed to assess for new risk factors and current symptoms of active, TB disease. Further testing may be required if:  • the facility is NOT considered low-risk on the annual, TB Facility Risk Assessment (or)  • the HCW has had known, direct exposure to a patient with active, TB disease within the previous year (or)  • the HCW has visited a country identified as TB endemic: within Africa, Asia/Pacific, Eastern Europe (including Russia), Latin America (including Mexico) (or)  • the HCW has symptoms compatible with active, TB disease in the absence of another diagnosis

13. Documentation  Documentation shall be maintained onsite for the following:  • Annual TB Facility Risk Assessment Tool • Employee name and demographics • TB screening results at date of employment or credentialing • TST dates and times of administration and date and time of read results, including measurement of induration AND interpretation of results • Dates / results of other diagnostic tests (eg, IGRA, CXR, sputum smear & culture) • Summary of treatment, including date (as appropriate) • Name and telephone number of treating physician

15. Nuedexta Misuse  While drugmakerAvanir Pharmaceuticals has said that many dementia patients suffer from PBA, regulators are concerned that Medicare may be paying for the drug for unapproved and potentially fraudulent uses.  Prescribing for unapproved uses is not illegal, but diagnosing a patient with a condition in order to secure Medicare coverage is considered fraud. A CNN investigation found Avinar had been aggressively targeting frail, elderly NH residents for whom the drug may be unnecessary or unsafe, including examples in which providers had inappropriately prescribed Nuedexta to dementia patients, using a PBA diagnosis when it was actually being prescribed to control unruly behaviors.

16. Nuedexta Misuse  While drugmakerAvanir Pharmaceuticals says that many dementia patients suffer from PBA, regulators are concerned that Medicare may be paying for it for unapproved and potentially fraudulent uses.  Prescribing for unapproved uses is not illegal, but diagnosing a patient with a condition in order to secure Medicare coverage is considered fraud. A CNN investigation found Avinar had been aggressively targeting frail, elderly NH residents for whom the drug may be unnecessary or unsafe, including examples in which providers had inappropriately prescribed Nuedexta to dementia patients, using a PBA diagnosis when it was actually being prescribed to control unruly behaviors. An Ohio physician prescribing the drug was accused of accepting kickbacks in exchange for prescribing it and fraudulently diagnosing patients with PBA to secure Medicare coverage.