Title of Rule and Other Identifying Information: WAC 246-840-4651 Patient notification, secure storage, and disposal, the nursing care quality assurance commission (commission) proposes amendments to existing rule to implement the legislative requirement of SSB 5380 (section 10, chapter 314, Laws of 2019), regarding patient notification for right to refuse an opioid prescription or order and the corresponding documentation.

Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Section 10 of SSB 5380 directs the commission to adopt or amend rules establishing the requirement for advanced registered nurse practitioners (ARNP) to notify patients of their right to refuse an opioid prescription or order, and the requirement for ARNPs to document any refusal in the patient's record. SSB 5380 requires the commission to adopt or amend rules by January 1, 2020.

Reasons Supporting Proposal: The commission proposes amending WAC 246-840-4651, with language nearly identical to section 10, to satisfy the legislative requirement. This proposed rule change meets the intent of RCW 34.05.353 [(1)](d) for the expedited rule-making process by adopting rules explicitly and specifically dictated by statute. Adopting rules under the expedited procedure also allows the commission to meet the statutory deadline of January 1, 2020.

Name of Agency Personnel Responsible for Drafting: Amber Zawislak-Bielaski, 111 Israel Road S.E. Tumwater, WA 98504, 360-236-4785; Implementation: Chris Archuleta, 111 Israel Road S.E., Tumwater, WA 98504, 360-236-2748; and Enforcement: Catherine Woodard, 111 Israel Road S.E. Tumwater, WA 98504, 360-236-4757.

Explanation of the Reason the Agency Believes the Expedited Rule-Making Process is Appropriate: This proposed rule change meets the intent of RCW 34.05.353 [(1)](d) for the expedited rule-making process by adopting rules explicitly and specifically dictated by SSB 5380 (section 10, chapter 314, Laws of 2019).

THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Chris Archuleta, Nursing Care Quality Assurance Commission, P.O. Box 47864, Olympia, WA 98504, phone 360-236-2748, fax 360-236-4738, email https://fortress.wa.gov/doh/policyreview, AND RECEIVED BY November 4, 2019.

(1) The practitioner shall provide information to the patient educating them of:

(a) Risks associated with the use of opioids as appropriate to the medical condition, the type of patient, and the phase of treatment;

(b) The safe and secure storage of opioid prescriptions; ((and))

(c) The proper disposal of unused opioid medications including, but not limited to, the availability of recognized drug take-back programs; and

(d) The patient's right to refuse an opioid prescription or order for any reason.

(2) The practitioner shall document such notification in the patient record. If the patient refuses an opioid prescription or order, the practitioner must document the patient's request and avoid prescribing or ordering opioids, unless the request is revoked by the patient.

(3) Patient notification must occur, at a minimum, at the following points of treatment:

(a) The first issuance of a prescription for an opioid; and

(b) The transition between phases of treatment, as follows:

(i) Acute nonoperative pain or acute perioperative pain to subacute pain; and

(ii) Subacute pain to chronic pain.