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AUS3024
WHAT’S INSIDE
Clinical Management of Substance Use Disorders
1
[5 contact hours] [5 pharmacology hours] Substance use and abuse cost society more than $740 billion annually in workplace productivity, healthcare, and crime-related expenses (NIDA, 2020). Substance use disorders are complex phenomena affecting individuals’ and families’ lives. This course reviews common substance use disorders, including alcohol, anxiolytics, stimulants, hallucinogens, and tobacco/vaping. The course also examines federal and state-controlled substance regulations and the prescribing practices for controlled substances. The focus is on clinical and safety considerations by nurse practitioners when prescribing non-cancer-related opioid medications for acute/chronic pain. Identifying Common Rashes in Urgent Care: A Case Study Approach for APRNs 33 [4 contact hours] [2 pharmacology hours] Family nurse practitioners (FNPs) and emergency nurse practitioners (ENPs) care for patients with many ailments in the emergency department (ED). Some patients with low acute conditions make many ED visits, which contributes to service overcrowding and a large number of visits classified by providers as inappropriate (Pacheco et al., 2019). Most emergency departments have an area for minor injuries and acute exacerbations of chronic conditions. Fast-track and urgent care centers are typically staffed by nurse practitioners (NPs) and physician associates (PAs). Some primary care offices provide urgent care visits as walk-ins. Dermatological complaints constitute 5%–8% of all emergency department (ED) visits (Kilic et al., 2019). In one study, more than half (58.9%) of dermatologic ED visits were due to cellulitis plus abscess (Nadkarni et al., 2016). Knowing common dermatologic presentations may help providers educate patients about the proper care for skin conditions and potentially impact ED utilization. The purpose of this course is to characterize the most common dermatologic diagnoses in the urgent care setting. The goal is to build provider confidence in assessing, diagnosing, and treating rashes in the urgent care setting. Management of Atrial Fibrillation for APRNs 56 [2 contact hours] [2 pharmacology hours] Atrial fibrillation is a common healthcare problem. This course reviews the concepts of cardiac output, risk factors for atrial fibrillation (AF), classifications of AF, the pearls of obtaining a history and physical of a patient with AF, diagnostic testing, and the overall implications for pharmacologic management. APRN prescribing considerations and evidence-based practice guidelines are included in this course. Pain Management: Evidence-Based Guidance for Prescribing Opioids 68 [5 contact hours] [5 pharmacology hours] This course will provide a general review of federal and state-controlled substance regulations and the prescribing practices for controlled substances, including drug diversion. However, the focus is on clinical safety considerations when prescribing non- cancer-related opioid medications for acute/chronic pain in adults. Pharmacological Management: Type 1 Diabetes in Children, 2nd Edition 97 [3 contact hours] [3 pharmacology hours] The purpose of this course is to review diagnostic criteria, insulin pharmacokinetics and dosing strategies, hypoglycemia management, and psychosocial considerations in the pediatric type 1 diabetes mellitus patient. Diabetes is one of the most common chronic diseases in pediatric patients, and newly diagnosed cases are on the rise. Management of type 1 diabetes mellitus requires specialized knowledge and individualized treatment plans. All pediatric healthcare professionals should be equipped to help patients achieve glycemic control through optimized therapy and continual education. Prescribing Controlled Substances Safely: A DEA Requirement 112 [8 contact hours] [8 pharmacology hours] Nurse Practitioners (NPs), Physician Assistants (PAs), Pharmacists, and Dentists care for patients with disorders in many healthcare settings. Individuals may seek care for an acute illness or worsening of a chronic condition. Often, pain is the leading reason for seeking medical care. Appropriate prescribing practices are critical for all medications, but controlled substances require special attention. The Drug Enforcement Agency (DEA), the Food and Drug Administration (FDA), and the U.S. Department of Health and Human Services (HHS) all have a role in controlled medication schedules. Prescribers must understand federal and state requirements for all controlled substances. This course will provide a general review of federal and state-controlled substance regulations and the prescribing practices for controlled substances. Additionally, substance use disorders are complex phenomena affecting many lives. This course also reviews common substance use disorders, including alcohol, anxiolytics, stimulants, hallucinogens, and tobacco/vaping. However, the focus is on clinical safety considerations when prescribing non-cancer-related opioid medications for acute/chronic pain in adults. Using Evidence in Clinical Nursing Practice, 2nd Edition 150 [3 contact hours] Evidence-based practice (EBP) relies on scientific research findings to modify or develop policies and procedures that incorporate the latest evidence into clinical practice. The purpose of this course is to help nurses incorporate nursing research findings into their practice for the maximum benefit of patients and the facilitation of professional growth and development. Course Participant Sheet 165 ©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
i
NURSING CONTINUING EDUCATION
Book code: AUS3024
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal?
Contact Hours Requires Review our chart of the following pages, find your state and your required contact hours.
How much will it cost?
Contact Hours
Pharmacology Hours
Price
Course Title
Clinical Management of Substance Use Disorders
5
5
$34.95
Identifying Common Rashes in Urgent Care: A Case Study Approach for APRNs
4
2
$26.95
Management of Atrial Fibrillation for APRNs
2
2
$23.95
Pain Management: Evidence-Based Guidance for Prescribing Opioids
5
5
$34.95
Pharmacological Management: Type 1 Diabetes in Children, 2nd Edition
3
3
$28.95
Prescribing Controlled Substances Safely: A DEA Requirement
8
8
$79.95
Using Evidence in Clinical Nursing Practice, 2nd Edition
3
$23.95
Best Value - Save $180.70 - All 30 Hours
30
25
$72.95
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you approved by ANCC? Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Are my contact hours reported to my state board? We will report your hours electronically to the following boards: Alabama, Arkansas, District of Columbia, Florida, Georgia, Kentucky, Michigan, Mississippi, New Mexico, North Dakota, South Carolina, and West Virginia. All other states the boards perform random audits at which time proof of continuing education must be provided. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory subjects (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Nursing you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-866-344-0971, Monday - Friday 9:00 am - 6:00 pm, EST.
ii
Book Code: AUS3024
NURSING CONTINUING EDUCATION
HOW TO COMPLETE THIS BOOK FOR CREDIT
Please read these instructions before proceeding. IF YOU’RE COMPLETING ALL COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code AUS3024 in the book code box, then click GO . • If you already have an account created, sign in with your username and password. If you don’t have an account, you’ll be able to create one now.
• Follow the online instructions to complete your final exam. Once you finish your purchase, you’ll receive access to your completion certificate. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code that corresponds to the course below, then click GO . Each course will need completed individually.
COURSES YOU’VE COMPLETED
CODE TO ENTER
All 30 hours in this correspondence book Clinical Management of Substance Use Disorders
AUS3024
ANCCUS05SD
ANCCUS04IR
Identifying Common Rashes in Urgent Care: A Case Study Approach for APRNs
ANCCUS02AF
Management of Atrial Fibrillation for APRNs
ANCCUS05PG
Pain Management: Evidence-Based Guidance for Prescribing Opioids
ANCCUS03DC
Pharmacological Management: Type 1 Diabetes in Children, 2nd Edition
ANCCUS08DR
Prescribing Controlled Substances Safely: A DEA Requirement
ANCCUS03UE
Using Evidence in Clinical Nursing Practice, 2nd Edition
By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
iii
NURSING CONTINUING EDUCATION
Book Code: AUS3024
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
24
Alabama
24 LPNs, RNs, and APRNs - CRNPs are required to complete 24 contact hours of CE every 2-year renewal period. Contact hours must include: ● Board Functions, the Nurse Practice Act, Regulations, Professional Conduct, and Accountability – 4 contact hours at 1st renewal period.
Requirement for APRNs - CRNPs & CNSs with prescriptive authority: ● Pharmacology – 6 contact hours every 2-year renewal period. For more information visit the Alabama Board of Nursing website.
30
Alaska
30 LPNs, RNs, and APRNs - ANPs are required to complete 2 of the following every 2-year renewal period: ● 30 contact hours of CE. ● 30 contact hours of professional nursing activity. ● 320 hours of nursing employment. Requirement for APRNs with prescriptive authority: ● Advanced Pharmacology and Clinical Management of Drug Therapy - 15 hours every 2-year renewal period ● Pain Management and Opioid Use and Addiction - 2 hours every renewal period to renewal federal DEA registration For more information visit the Alaska Board of Nursing website. 0 3 hours Schedule II drugs for APRN prescribers. APRNs are required to maintain national certification. 4-year renewal period. For more information visit the Arizona Board of Nursing website. 20 LPNs, RNs, and APRNs are required to complete 1 of the following every 2-year renewal period: ● 15 contact hours of accredited practice-focused activities. ● Hold a current nationally recognized certification/recertification. ● Completed a minimum of 1 college credit hour nursing course with a C grade or better. Additional requirements for APRNs with prescriptive authority: ● Pharmacotherapeutics - 5 contact hours every 2-year renewal period including 2 hours containing information related to professional boundaries and prescribing rules For more information visit the Arkansas Board of Nursing website. 30 LPNs, RNs, and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the California Board of Nursing website. 0 LPNs, RNs, and APRNs – No CE requirements at this time. 2-year renewal period. For more information visit the Colorado Board of Nursing website. 50 APRNs are required to complete 50 contact hours of CE every 2-year renewal period. Contact hours must include: ● Mental Health Common to Veterans and Family Members of Veterans – 2 contact hours every 6-year renewal period. ● HIV and AIDS – 1 contact hour every 2-year renewal period. ● Risk Management – 1 contact hour every 2-year renewal period. ● Domestic Violence – 1 contact hour every 2-year renewal period. ● Sexual Assault – 1 contact hour every 2-year renewal period. ● Cultural Competency – 1 contact hour every 2-year renewal period. ● Substance Abuse – 1 contact hour every 2-year renewal period. ● Diagnosing and Treating Cognitive or Mental Health Conditions - 2 contact hours every 6-year renewal period Additional requirement for APRNs with prescriptive authority: 30 RNs are required to complete 30 contact hours of CE every 2-year renewal period. APRNs are required to maintain national certification. Contact hours must include: ● Substance Abuse – 3 contact hours every 2-year renewal period. Additional requirement for APRNs with prescriptive authority: ● Substance Abuse - 2 hours (can be met by the 3 hours required to renew RN license) For more information visit the Delaware Board of Nursing website. 24 RNs and APRNs are required to complete 24 contact hours of CE every 2-year renewal period. LPN, RN, and APRN CE contact hours must include: ● Director determined Public Health Priorities - 10% of total hours ● Pharmacotherapeutics – 5 contact hours every 2-year renewal period. For more information visit the Connecticut Board of Nursing website.
0
Arizona
20
Arkansas
30
California
0
Colorado
50
Connecticut
30
Delaware
24
District of Columbia
● LGBTQ - 2 contact hours every 2-year renewal period. Additional requirement for APRNs with prescriptive authority: ● Advanced Pharmacology – 15 contact hours every renewal period. For more information visit the Washington DC Board of Nursing website.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
iv
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
27
Florida
27 LPNs and RNs are required to complete 24 contact hours of CE every 2-year renewal period. APRNs are required to complete 27 contact hours of CE every 2-year renewal period. LPNs, RNs, and APRNs CE contact hours must include: ● Prevention of Medical Errors – 2 contact hours every 2-year renewal period. ● Florida Laws and Rules – 2 contact hours every 2-year renewal period. ● NEW Human Trafficking – 2 contact hours every 2-year renewal period. ● HIV/AIDS – 1 contact hour; 1-time requirement. ● Recognizing Impairment in the Workplace: ○ LPNs and RNs - 2 contact hours every other renewal (the license will include 27 contact hours during the renewal period when taken). ○ APRNs - 2 contact hours every other renewal (the license will include 30 contact hours during the renewal period when taken). ● Domestic Violence: ○ LPNs and RNs: 2 contact hours every 3rd renewal (the license will include 26 contact hours during the renewal period when taken). ○ APRNs: 2 contact hours every 3rd renewal (the license will include 29 contact hours during the renewal period when taken). Additional requirement for APRNs with prescriptive authority: ● Safe and Effective Prescription of Controlled Substances – 3 contact hours every 2-year renewal period. For more information visit the Florida Board of Nursing website. 30 RNs and APRNs are required to complete 30 contact hours of CE. 2-year renewal period. For more information visit the Georgia Board of Nursing website. 30 APRNs are required to maintain national certification and complete 30 contact hours of CE every 2-year renewal period.
30
Georgia
30
Hawaii
Additional requirement for APRNs with prescriptive authority: ● Pharmacology – 8 contact hours every 2-year renewal period. For more information visit the Hawaii Board of Nursing website. APRNs must maintain national certification. For more information visit the Idaho Board of Nursing website.
0
Idaho
0
80
Illinois
80 APRNs are required to complete 80 contact hours of CE every 2-year renewal period. Contact hours must include: ● Pharmacology – 20 contact hours every 2-year renewal period to include 10 contact hours in Controlled Substances. ● Sexual Harassment Prevention - 1 hour ● Implicit Bias Training - 1 hour ● DCFS Mandated Reporter Training - 1 hour within 3 months of initial licensure and at least every 3 years thereafter ● Diagnosis, Treatment, and Care of Individuals with Alzheimer disease and other dementias - 1 hour, if licensee provides provides health care services to patients 26 years of age and older For more information visit the Illinois Board of Nursing website. 30 APRNs are required to maintain national certification and complete 30 contact hours of CE every 2-year renewal period. Additional requirement for APRNs with prescriptive authority: ● Pharmacology – 8 contact hours every 2-year renewal period. ● Opioid Abuse - 2 contact hours for APRNs who have controlled substance registration. For more information visit the Indiana Board of Nursing website. 36 ARNPs are required to complete 36 contact hours of CE and maintain certification in specialty area of practice. 3-year renewal period. ● Every 5 years the renewal requires 2 contact hours of CE for Identification and Reporting of Child/Dependent Adult Abuse (must be a state-approved course). 30 LPNs, RNs, and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the Kansas Board of Nursing website. 14 LPNs, RNs, and APRNs are required to complete 14 contact hours of CE annually. Contact hours must include: ● Domestic Violence – 3 contact hours; 1-time requirement. ● Pediatric Abusive Head Trauma – 1.5 contact hours; 1-time requirement. ● Suicide Prevention - 2 hours, 1-time requirement within 3 years of initial license ● Implicit Bias - 1.5 hours, 1-time requirement within 3 years of initial license Requirements every renewal period for APRNs with prescriptive authority: ● Pharmacology - 5 contact hours ● Pharmacology and either pain management or addiction disorders - 1.5 of the 5 pharmacology hours for APRNs with CAPA-CS. ● Addiction Disorders - 4 hours, which must include 1.5 hours in addiction disorders and pharmacology, for APRNs with DEA-X registration. These hours can be applied to the 5 hour pharmacology requirement. For more information visit the Kentucky Board of Nursing website. 30 RNs are required 30 hours of CE OR 900 practice hours every 2-year renewal period. APRNs meet the CE requirement through maintaining a national board certification. ● Prescribing Opioids - 2 hours for ARNPs who prescribe. For more information visit the Iowa Board of Nursing website.
30
Indiana
36
Iowa
30
Kansas
14
Kentucky
30
Louisiana
Additional requirement for APRNs with prescriptive authority: ● Pharmacology – 12 contact hours every renewal period. For more information visit the Louisiana Board of Nursing website.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
v
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
50
Maine
50 APRNs are required to complete 50 contact hours of CE every 2-year renewal period. Requirement for APRNs with prescriptive authority: ● Prescribing Opioids - 3 hours For more information visit the Maine Board of Nursing website. 0 APRNs are required to maintain national certification. 2-year renewal period. For more information visit the Maryland Board of Nursing website. 15 APRNs are required to maintain national certification and complete 15 contact hours of CE every 25 LPNs, RNs, and APRNs are required to complete 25 contact hours of CE every 2-year renewal period. Contact hours must include: ● Pain and Symptom Management – 2 contact hours every 2-year renewal period. ● Per the State Board of Nursing, the following is a 1-time REQUIRED COURSE, but CAN NOT count toward total required CE contact hours: ● Human Trafficking. 24 Current APRN certification on file at the Board will meet the 24 contact hours of continuing education for the RN license. For more information visit the Minnesota Board of Nursing website. 5 APRNs are required to maintain national certification and complete a minimum of 5 contact hours of continuing education related to controlled substances per renewal period. For more information visit the Mississippi Board of Nursing website. 2-year renewal period. Contact hours must include Pain Management. For more information visit the Massachusetts Board of Nursing website. ● Implicit Bias Training - 2 hours every 2-year renewal period For more information visit the Michigan Board of Nursing website. 0 APRNs are required to maintain national certification. 2-year renewal period. For more information visit the Missouri Board of Nursing website. 24 LPNs, RNs, and APRNs are required to complete 24 contact hours of CE every 2-year renewal period. Requirements for APRNs with prescriptive authority: ● Pharmacotherapeutics - 12 hours every renewal period For more information visit the Montana Board of Nursing website. 20 APRNs are required to maintain a Nebraska RN license or NLC multistate license. Requirements for APRNs who prescribe controlled substances: ● Prescribing Opiates - 3 hours, one half-hour must be about the PDMP. For more information visit the Nebraska Board of Nursing website. 45 APRNs are required to complete 45 contact hours of CE every 2-year renewal period. Contact hours must include: ● Bioterrorism: Responding to Acts of Terrorism – 4 contact hours; 1-time requirement. ● Cultural competency and diversity, equity and inclusion - 2 hours ● NEW! Beginning with renewals on or after January 1, 2024, all licensees are required to have 4, rather than 2, hours in cultural competency and diversity, equity and inclusion ● Suicide prevention - 2 hours (within first two years of initial licensure and every 4 years thereafter) ● Substance use disorder - 2 hours ● NEW! Beginning with renewals on or after January 1, 2024, all licensees are required to have 2 hours in substance use disorder ● Misuse and abuse of controlled substances, prescribing of opioids and addiction - 2 hours (all APRNs who have the authority to prescribe controlled substances) ● 15 hours - Area of practice For more information visit the Nevada Board of Nursing website. 60 APRNs are required to complete 60 contact hours of CE every 2-year renewal period. Contact hours must include: ● Role or specialty – 30 contact hours every 2-year renewal period. ● Pharmacology (opioid prescribing, pain management, or substance abuse) – 5 contact hours every 2-year renewal period. ○ Opioid Prescribing - 3 hours of the 5 Pharmacology hours For more information visit the New Hampshire Board of Nursing website. 30 ● Every biennial period, an advanced practice nurse shall complete the continuing educa- tion required for the renewal of a registered professional nurse license and the continuing education requirements of the national certifying agency whose examination the advanced practice nurse successfully passed. ● This includes at least one (1) hour in topics concerning prescription opioid drugs, and two (2) hours in programs or topics related to end-of-life care. For more information visit the New Jersey Board of Nursing website. 30 APRNs are required to complete 30 contact hours of CE every 2-year renewal period. Contact hours must include: ● Specialty or Role – 5 contact hours every 2-year renewal period. ● Pain Management for Advanced Practice – 5 contact hours every 2-year renewal period. ● Pharmacology – 15 contact hours every 2-year renewal period. ○ For APRNs with prescriptive authority, 5 of the 15 contact hours must include Management of Non-Cancer or Chronic Pain every 2-year renewal period. For more information visit the New Mexico Board of Nursing website.
0
Maryland
15
Massachusetts
25
Michigan
24
Minnesota
5
Mississippi
0
Missouri
24
Montana
20
Nebraska
45
Nevada
60
New Hampshire
30
New Jersey
30
New Mexico
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
vi
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
5
New York
5 APRNs must maintain national certification and complete state requirements each renewal period. Contact hours must include:
● Child Abuse – 2 contact hours; 1-time requirement for initial renewal. ● Infection Control – 3 contact hours every 4-year renewal period. For more information visit the New York Board of Nursing website.
50
North Carolina
50 APRNs are required to complete 50 contact hours of CE every annual renewal period. Contact hours must include: ● Safe Prescribing Practices – 1 contact hour every annual renewal period. ● A minimum of 20 hours must be in the advanced practice nursing population of the role For more information visit the North Carolina Board of Nursing website. 27 APRNs are required to complete 12 contact hours of CE plus 15 contact hours of Pharmacotherapy every 2-year renewal period. For more information visit the North Dakota Board of Nursing website. 48 APRNs are required to complete 24 hours of CE for each APRN license held in addition to the 24 hours of CE required to renew the RN license. Contact hours must include: APRNs without previous prescriptive authority are required to complete the RN requirements for re-licensure plus a one-time requirement equal to a total of 45 contact hours in advanced pharmacology. For more information visit the Ohio Board of Nursing website. ● Pharmacology – 12 contact hours every 2-year renewal period. ● Ohio Laws and Rules – 1 contact hour every renewal period. 36 APRNs are required to maintain national certification every 2-year renewal period. Additional requirement for APRNs with prescriptive authority: ● Pharmacotherapeutics, Clinical Application and Use of Pharmacological Agents, and the Restoration and Maintenance of Health – 15 contact hours of CE or 1 academic credit hour every 2-year renewal period. ● Pain Management or Opioid Use or Addiction - 2 hours every renewal period. For more information visit the Oklahoma Board of Nursing website. 45 APRNs are required to maintain national certification congruent with license type and specialty. For those APRN-NPs initially licensed prior to January 1, 2011, a minimum of 45 hours of CE is required. Contact hours must include: ● Oregon Pain Management Commission Module - 1 hour every renewal. ● Cultural Competency - 2 hours every renewal. Additional requirement for APRNs with prescriptive authority: ● Advanced Pharmacology - 15 contact hours every 2-year renewal period. For more information visit the Oregon Board of Nursing website. 30 RNs and APRNs - CRNPs are required to complete 30 contact hours every 2-year renewal period. Contact hours must include: ● Child Abuse Recognition and Reporting - 3 contact hours (initially) and 2 contact hours thereafter every 2-year renewal period. Additional APRN - CRNP requirements: ● Pain Management, the Identification of Addiction or in the Practices of Prescribing or Dispensing Opioids – 4 contact hours every renewal period. For more information visit the Pennsylvania Board of Nursing website. 10 LPNs, RNs, and APRNs are required to complete 10 contact hours of CE every 2-year renewal period. Contact hours must include: ● Substance Abuse - 2 contact hours every 2-year renewal period. Additional requirement for APRNs with prescriptive authority: ● Pharmacology of Psychotropic Drugs – 30 contact hours every 6-year renewal period. For more information visit the Rhode Island Board of Nursing website. 30 LPNs, RNs and APRNs are required to complete 30 contact hours of CE every 2-year renewal period. For more information visit the South Carolina Board of Nursing website. 0 LPNs, RNs and APRNs - No CE requirements at this time. 2-year renewal period. For more information visit the South Dakota Board of Nursing website. 2 APRNs are required to maintain national certification and complete 2 contact hours of CE every 2-year renewal period. Contact hours must include: ● Controlled Substances and Prescribing Practices – 2 contact hours every 2-year renewal period. For more information visit the Tennessee Board of Nursing website.
27
North Dakota
48
Ohio
36
Oklahoma
45
Oregon
30
Pennsylvania
10
Rhode Island
30
South Carolina
0
South Dakota
2
Tennessee
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
vii
STATE BY STATE REQUIREMENT GUIDE
STATE
HOURS ALLOWED BY HOMESTUDY
TOTAL HOURS REQUIRED
28
Texas
28 LVNs, RNs and APRNs are required to either maintain/re-new national certification or complete 20 contact hours of CE every 2-year renewal period. Contact hours must include: ● Texas Nursing Jurisprudence and Ethics – 2 contact hours every third 2-year renewal period. ● Older Adult/Geriatric Care – 2 contact hours every renewal period. Additional requirement for APRNs with prescriptive authority (for a total of 28 contact hours): ● Pharmacotherapeutics – 5 contact hours every 2-year renewal period. ● Prescribing Controlled Substances – 3 contact hours every 2-year renewal period. Recommended: ● Tick-borne diseases, diagnosis and treatment (hours unspecified). Additional requirement for emergency department nurses (LVNs, RNs and APRNs): ● Forensic Evidence Collection – 2 contact hours; 1-time requirement. For more information visit the Texas Board of Nursing website. 30 APRNs are required to maintain certification in specialty area of practice or if licensed prior to 7/1/92, must have practiced at least 400 hours in the last 2 years and have completed 30 contact hours of CE. Additional requirements for APRNs with prescriptive authority: ● Controlled Substances - 3.5 contact hours every 2-year renewal period. ● Division of Occupational and Professional Licensing (DOPL) tutorial – 0.5 contact hours every 2-year renewal period. For more information visit the Utah Board of Nursing website.
30
Utah
0
Vermont
0
APRNs are required to maintain national certification. For more information visit the Vermont Board of Nursing website.
Up to 40
Virginia
Up to 40
APRN requirements: ● If initially licensed on or after May 8, 2002, required to maintain professional certification in area of specialty practice every 2-year renewal period. ● If licensed prior to May 8, 2002, required to maintain professional certification in area of specialty practice and complete 40 contact hours of CE every 2-year renewal period. Contact hours must include: ○ Pharmacology – 8 contact hours every 2-year renewal period. Additional requirements for APRNs with prescriptive authority: ● Controlled Substances – 2 contact hours of Type 1 (CAT I) every 2-year renewal period. For more information visit the Virginia Board of Nursing website.
45
Washington
45 APRNs are required to complete 30 contact hours of CE every 2-year renewal period. LPNs, RNs, and APRNs contact hours must include: ● Suicide Prevention - 6 contact hours; 1-time requirement. Additional requirement for APRNs with prescriptive authority: ● Advanced Pharmacology – Additional 15 contact hours every 2-year renewal period. For more information visit the Washington Board of Nursing website. 24 APRNs are required to complete 24 contact hours of CE every 2-year renewal period. Contact hours must include: ● Pharmacotherapeutics – 12 contact hours every 2-year renewal period; 8 contact hours may be used for renewal/reinstatement of Limited Prescriptive Authority. ● Clinical Management of Patients – 12 contact hours every 2-year renewal period. For more information visit the West Virginia Board of Nursing website. 16 APRNs are required to complete 16 contact hours of CE every 2-year renewal period in clinical pharmacology or therapeutics relevant to area of practice, including at least 2 contact hours in Responsible Prescribing of Controlled Substances. For more information visit the Wisconsin Board of Nursing website.
24
West Virginia
16
Wisconsin
Up to 60
Wyoming
Up to 60
APRNs are required to maintain national licensure in specialty area of practice. ● If initially licensed prior to July 1, 2005 and has maintained continuous recognition, but is not nationally certified, must complete 60 contact hours of CE in specialty area of practice and complete 400 hours practicing as an APRN during the last 2 years. APRNs with prescriptive authority are required to complete 15 contact hours of CE every 2-year renewal period. Contact hours must include: ● Responsible Prescribing of Controlled Substances or Treatment of Substance Use Disorders - 3 contact hours every 2-year renewal. For more information visit the Wyoming Board of Nursing website.
NOTE: CE Rules can change. Always check your state board for the most up-to-date information.
viii
Clinical Management of Substance Use Disorders 5 Contact Hours, 5 Pharmacology Hours
Release Date: July 10, 2023
Expiration Date: July 10, 2026
Faculty Humberto Reinoso, Ph.D, FNP-BC, ENP-BC received his Ph.D. from Barry University in Miami, Florida. He incorporates current guidelines and real-world scenarios as innovative pedagogical content delivery methods. His passion for nursing education has evolved as healthcare demands on the practitioner, patient, and community have become more complex. Preparing nurses to sharpen their skills and perform at the level of advanced practice providers has become his passion. His pedagogical approach Course overview Substance use and abuse cost society more than $740 billion annually in workplace productivity, healthcare, and crime-related expenses (NIDA, 2020). Substance use disorders are complex phenomena affecting individuals’ and families’ lives. This course reviews common substance use disorders, including alcohol, anxiolytics, stimulants, hallucinogens, and tobacco/vaping. The Learning objectives After completing this course, the learner should be able to: Examine substance use disorders. Examine essential considerations when prescribing controlled substances, including regulatory and clinical concerns. How to receive credit ● Read the entire course online or in print which requires a 5-hour commitment of time. ● Complete the self-assessment quiz questions which are at the end of the course or integrated throughout the course. These questions are NOT GRADED. The correct answer is shown after you answer the question. If the incorrect answer is selected, the rationale for the correct answer is provided. These questions help to affirm what you have learned from the course. ● Depending on your state requirements you will be asked to complete either: CE Broker reporting Colibri Healthcare, LLC, provider # 50-4007, reports course completion results within 1 business day to CE Broker. If you are licensed in Arkansas, District of Columbia, Florida, Georgia, Accreditations and approvals Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. Individual state nursing approvals Colibri Healthcare, LLC is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. In addition to states that accept courses offered by ANCC Accredited Providers, Colibri Healthcare, LLC is an approved Provider of continuing education in nursing by: Alabama Board of Nursing, Provider #ABNP1418 (valid through February 5, 2025); Arkansas State Board of Nursing, Provider #50-4007; California Board of Registered Nursing, Provider #CEP17480 (valid through January 31, 2024); California Board of Vocational Nursing and Psychiatric Technicians (LVN Provider #V15058, PT Provider #V15020; valid through December 31, 2023); District of Columbia Board of
focuses on bridging clinical practice with theoretical/didactic content. As an Assistant Professor and the Nurse Practitioner Coordinator at Georgia Baptist College of Nursing of Mercer University, he can combine his passion for clinical practice and the education of future advanced practice professionals. Humberto Reinoso has disclosed that he has no significant financial or other conflicts of interest pertaining to this course. course also examines federal and state-controlled substance regulations and the prescribing practices for controlled substances. The focus is on clinical and safety considerations by nurse practitioners when prescribing non-cancerrelated opioid medications for acute/chronic pain.
Describe controlled substance prescribing practices. Discuss drug diversion in healthcare practitioners.
○ An affirmation that you have completed the educational activity. ○ A mandatory test (a passing score of 70 percent is required). Test questions link content to learning objectives as a method to enhance individualized learning and material retention. ● If requested, provide required personal information and payment information. ● Complete the MANDATORY Course Evaluation. ● Print your Certificate of Completion.
Kentucky, Michigan, Mississippi, New Mexico, North Dakota, South Carolina, or West Virginia, your successful completion results will be automatically reported for you.
Nursing, Provider #50-4007; Florida Board of Nursing, Provider #50-4007; Georgia Board of Nursing, Provider #50-4007; Kentucky Board of Nursing, Provider #7-0076 (valid through December 31, 2023; CE Broker Provider #50-4007); Michigan Board of Nursing, Provider #50-4007; Mississippi Board of Nursing, Provider #50- 4007; New Mexico Board of Nursing, Provider #50-4007; North Dakota Board of Nursing, Provider #50-4007; South Carolina Board of Nursing, Provider #50-4007; and West Virginia Board of Registered Nurses, Provider #50-4007. This CE program satisfies the Massachusetts States Board’s regulatory requirements as defined in 244 CMR5.00: Continuing Education.
Activity director Deborah Martin, DNP, MBA, RN, NE-BC, FACHE, Director of Learning Innovation Colibri Healthcare, LLC
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Book Code: AUS3024
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Disclosures Resolution of conflict of interest
Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
In accordance with the ANCC Standards for Commercial Support for continuing education, Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative
to diagnostic and treatment options of a specific patient’s medical condition.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Course verification All individuals involved have disclosed that they have no No. 241, every reasonable effort has been made to ensure that the content in this course is balanced and unbiased. significant financial or other conflicts of interest pertaining to this course. Likewise, and in compliance with California Assembly Bill
SUBSTANCE-RELATED DISORDERS
Substance use disorders are a significant public health problem with a wide range of adverse effects on individuals’ mental, physical, and social well-being. Mental health problems that co- occur with substance use disorders include depressive, anxiety, and psychotic disorders, as well as organic brain syndromes (American Psychiatric Association [APA], 2013). Substance use disorders share many of the same features but differ in pharmacology and associated behaviors that account for the unique effects of each substance (Boland & Verduin, 2022).
Alcohol, opioids, central nervous stimulants, cannabinoids, and tobacco are associated with substance disorders. Substance use disorders include cognitive, behavioral, and physiological symptoms that lead to intoxication, withdrawal, and dependence (APA, 2013). People with SUD have impaired functioning, regardless of presentation. Diagnosis is based on pathological patterns, but all substances activate the same brain reward pathway via dopaminergic neurotransmission (Paxos & Teter, 2019).
NEUROBIOLOGY OF SUBSTANCE USE DISORDERS
Substance use disorders (SUDs) are complicated physiologic and psychologic disorders with multiple intersecting factors, such as drug use behaviors and poor judgment influenced by the pharmacodynamics and pharmacokinetic actions of the drug (Boland & Verduin, 2022). The central element of drug dependence is drug-using behavior. Drug use initiates a cascade of rewarding or aversive physical, psychological, and social consequences that determine the likelihood of subsequent use (Boland & Verduin, 2022). The development and persistence of SUDs are primarily based on key components within the basal ganglia, amygdala (extended), and prefrontal cortex (U.S. Department of Health and Human Services [HHS], 2019a). The basal ganglia plays a role in positive motivation and pleasure, with key involvement in habits and routines in the reward circuit . Euphoria of drug highs are thought to produce overactivity in this circuit, causing chemical surges and signaling of endorphins and other neurotransmitters in the basal ganglia (National Institute on Drug Abuse [NIDA], 2020b). After repeated exposure, the reward circuit adapts to the drug, decreasing the individual’s ability to feel pleasure from anything except the drug (NIDA, 2020b). The amygdala plays a role in anxiety, irritability, and apprehension as the euphoria fades and the individual seeks the drug next high. The prefrontal cortex provides the ability to plan, solve problems, and demonstrate self-control (NIDA, 2020b). The circuit involvements of the amygdala and basal ganglia cause the individual to compulsively pursue drug use with very little impulse control. Since this is the last part of the brain to mature, teens are vulnerable to substance use. However, substance use disorder prevalence is highest among individuals aged 18–24 years (APA, 2013; NIDA, 2022).
Impulsivity causes the individual to act without forethought, the lack of reflection on previous behavior. They focus on immediate reward and display a failure of motor inhibition, choosing risky behavior while lacking the willpower to resist temptation (Stahl, 2020). Compulsivity is characterized by inappropriate actions which persist regardless of the situation (Stahl, 2020). Over time, impulsive substance use becomes compulsive addiction as this dysregulation becomes a dependent conditioned response. The impulses in the ventral loop of reward and motivation migrate dorsally because of neuroplasticity and engage in a habit system, creating the conditioned response of addiction (Stahl, 2020). Impulsive drug use produces a high, which, if experienced too often, causes the migration to compulsive use (addiction) to reduce the unpleasant effects of withdrawal. The mesolimbic pathway is hypothesized to be the final common pathway of reward and reinforcement in the brain, where all addictive drugs increase dopamine, especially with habitual use (Stahl, 2020; Wise & Jordan, 2021). Dopamine, the main neurotransmitter in substance use, is thought to reinforce pleasure rather than generating a direct effect. Pleasurable activities cause changes in neural activity leading to the formation of habit (NIDA, 2020b). Substance use causes powerful surges in dopamine, which lead the individual to repeat the activity without thought, leading to the drug habit. Daily activities in an individual’s life can trigger cravings, which can occur even when the drug has not been taken in a long time (NIDA, 2020b). The mesolimbic pathway is hypothesized to be the final common pathway of reward and reinforcement in the brain, where all addictive drugs increase dopamine, especially with habitual use (Stahl, 2020; Wise & Jordan, 2021). Addiction is now understood as a chronic, treatable brain disorder from which recovery is possible according to NIDA (2018).
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No single factor determines whether a person becomes addicted to drugs, and like other disorders, the risk increases in some individuals (NIDA, 2020b). Biological factors which influence risk include epigenetics, development stage, gender, weight, and ethnicity. Risk factors are an important consideration in the development of substance use disorders and include factors such as (1) aggressive childhood behavior, (2) lack of parental supervision, (3) drug availability at school, (4) drug experimentation, (5) decreased peer refusal skills, and (6) community poverty (NIDA, 2020b). Comorbidities such as mental illness increase substance use, and account for 40-60% of addiction risk. Protective factors are just as important and may decrease risk behaviors. These include (1) self-efficacy,
(2) parental monitoring and support, (3) positive relationships, family, and friends, (4) good grades, (5) school anti-drug policies, and (6) neighborhood resources (NIDA, 2020b). Self-Assessment Quiz Question #1 Which of the following is NOT a risk factor for developing substance use disorders?
a. Aggressive childhood behavior. b. Lack of parental supervision. c. Positive relationships with family and friends. d. Drug availability at school.
STIGMA AND IMPLICIT BIAS IN SUBSTANCE USE DISORDERS
Implicit bias exists in all of us, both positive and negative. Science has identified that the brain recognizes patterns and creates shortcuts to process overwhelming sensory information. A bias is one shortcut to process external information and exists even in those who pledge to be fair, including physicians, nurses, teachers, and judges. Words used by clinicians such as addicts can stigmatize individuals with substance use disorders reflecting misconceptions that these behaviors are choices rather than compulsions (NIDA, 2018). To this end, the word addiction has been eliminated from the DSM-5 ® (Diagnostic and Statistical Manual of Mental Disorders , 5th ed.) in favor of the more neutral substance use disorder (APA, 2013). Fortunately, the brain can also unlearn bias, which is accomplished by becoming self-aware and engaging in deliberate practice. Using appropriate terms, such as opioid use disorder , establishes a culture of respect. Negative biases can dehumanize individuals, affect the therapeutic alliance, and, ultimately, the course of recovery (NIDA, 2018). Stereotyping leads to healthcare disparities. Clinicians who stereotype drug use as a criminal activity marginalize disadvantaged groups and negatively influence treatment plans, which may increase drug use (NIDA, 2018). Stigma and implicit biases impact fear in disclosing substance use, decreased quality of care, or reduced access to care (NIDA, 2018). Transgender individuals are those whose gender identity differs from the sex assigned at birth and face disproportionately
higher rates of discrimination, violence, and other forms of stigma (Wolfe et al., 2021). Adverse mental and behavioral health outcomes, including post-traumatic stress disorder, depression, suicide attempts, and substance use are evident in the transgender community (Wolfe et al., 2021). Substance use is shown to provide a coping mechanism to deal with the discrimination that a majority of transgender individuals experience. Additionally, transgender individuals experience higher risks of developing substance use disorders than the general population (Wolfe et al., 2021). Unfortunately, this population may not receive an appropriate diagnosis because of decreased healthcare access or the avoidance of care because of the fear of stigma. Healthcare Considerations: Every member of our community may help to lessen stigma and prejudice against those who suffer from drug use disorders by: ● Understanding substance use disorders are chronic, treatable medical conditions. ● Changing stigmatizing language with more empowering, preferred language that does not equate people with their condition or have negative connotations. ● Addressing systemic racism, sexism, and other forms of discrimination leads to multiple layers of stigma for many people with addiction (NIDA, 2018).
RISK FACTORS FOR SUBSTANCE USE DISORDERS
Substance use is common worldwide, but use is not always indicative of a disorder. Research findings suggest variability in the speed at which a disorder develops (Marel et al., 2019). Progression for heroin is the quickest (0 months), followed by cocaine (0-4 years), cannabis (1-6 years), tobacco (1-27 years), and alcohol (3-15 years). This information is critical for implementing health promotion and early initiatives (Marel et al., 2019). Several risk factors also influence the likelihood and speed with which this occurs, including younger age of first use, biological
male gender, ethnicity, geographical place of birth, marital status, lower income, unemployment, and substance use history (Marel et al., 2019). A developmental perspective may suggest a gradual shift from late adolescence into adulthood when examining both patterns and predictors of use (Allen et al., 2021). The link between self-esteem and substance use is uncertain but can lead to greater contact with risk-taking behaviors among peers (Allen et al., 2021). However, poor adolescent self-esteem has been linked to many adult problems.
SUBSTANCE USE INTOXICATION
Substance intoxication is associated with and without substance use disorders. The most common changes with intoxication include disturbances in wakefulness, attention, thinking, judgment, psychomotor skills, and interpersonal behaviors (APA, 2013). Specific routes of administration produce rapid absorption into the bloodstream, escalating intoxication effects and the likelihood of patterns of use. Intoxication often begins
in teens and is the first substance-related disorder. Withdrawal is usually, but not always, associated with substance use disorders but can occur at any age. Short-acting substances have a higher potential for withdrawal than longer-acting substances. The substance’s half-life largely parallels withdrawal aspects (APA, 2013).
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Book Code: AUS3024
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