The Future of Nursing: A New AI Tool Helps Prescribe Pain Meds. Here’s What Nurses and Nursing Students Need to Know

• The NarxCare Report analyzes information from the state-directed computer system that collects and shows data about controlled substance prescription and dispensing.
• There is no "correct" NarxScore for narcotics, sedatives, and stimulants, according to Bamboo Health, formerly Appriss Health.
• The U.S. Center for Policy sent a petition to the U.S. Food and Drug Administration (FDA) to recall the NarxCare software.

An artificial intelligence (AI) tool called the NarxCare Report, developed by Bamboo Health, is making waves in the healthcare world by using algorithms to identify risk factors in pain medication prescribing.

The tool is controversial, however, even as it hints at the potential AI revolution that will await nursing students as they move into professional practice.

The NarxCare Report helps healthcare providers — potentially including nurse practitioners and others with prescribing authority — make decisions on the risk to a patient when prescribing a controlled substance like opioids, based on risk factors over time. The tool takes the risk factors and creates a Narx Score from 0-999 for every patient without considering sex, race, age, or other attributes.

What Is the NarxCare Report?

The tool helps healthcare providers understand data from a prescription drug-monitoring program (PDMP). This state-directed computer system collects and distributes data about controlled substance prescription and dispensing within the state.

The report uses the PDMP's existing data on potential patient risk factors and scores them in several risk categories, including narcotic, sedative, and stimulant "Narx Scores."

The Narx Score's risk factors include:

• The number of prescribers a patient has
• The number of pharmacies at which a patient fills medications
• The amount or strength of medication prescribed
• The number of additional medications (if any) that may increase other medications' potency (or risk). For example, some sedatives increase the amount of respiratory depression (slowed breathing) when combined with opioids.
• The number of times prescriptions overlap with other prescriptions from different prescribers

As the risks increase, so do the corresponding scores. However, if someone has been using higher doses of medications over a long time, it does not mean they will have a high score.

According to Bamboo Health (formerly Appriss Health), scores should help providers and patients be aware of prescription risks, not serve as a basis for prescribing decisions.

"Providers should always use the actual PDMP data to inform their clinical decision making and should always discuss any concerns with a patient prior to making or changing a prescribing or any other treatment decision."

Bamboo says there is also no "normal" Narx Score, and it may mean different things depending on the patient.

If a patient believes their healthcare provider inappropriately used their NarxCare Report and Narx Scores, Bamboo Health suggests asking the provider what underlying PDMP information was concerning.

What Do Narx Scores Mean?

If a patient has a 000 score, this may be the first time the patient is being prescribed this type of medication. Bamboo Health recommends discussing the risks and benefits of a controlled substance.

Approximately 75% of scores fall between 010-200. Bamboo Health recommends reviewing the patient's use patterns for unsafe practices and discussing any concerns with the patient.

Approximately 24% of scores fall between 201-650. Bamboo Health recommends the same guidance as for scores between 010-200.

Approximately 1% of scores are above 650. Some patients may have this score while being within prescriber expectations. Bamboo Health said many patients could have a range of multiple provider episodes, overlapping prescriptions, or elevated milligram equivalency.

Bamboo Health recommends reviewing the patient's use patterns and discussing multiple provider and pharmacy concerns.

If the patient has overlapping medications of the same or a different type, consider lowering medication. If there is evidence of substance misuse, consider inpatient or outpatient referral for evaluation and treatment.

Why Is This Tool Controversial?

The NarxCare Report may have a shaky future in healthcare if the U.S. Food and Drug Administration (FDA) considers a new petition against NarxCare.

The Center for U.S. Policy, a nonpartisan research and education organization focusing on substance use disorder prevention, sent a petition in April to the FDA calling for the NarxCare Report to be deemed a "misbranded device" and a recall of the software.

The petition, led by Center Senior Fellow Lynn R. Webster and Chairman Michael C. Barnes, alleges the manufacturer violates several regulations.

"FDA should deem NarxCare a misbranded device and take appropriate administrative action to prevent serious, adverse health consequences or death," the petition states.

"As explained herein, such administrative action is particularly important given that Bamboo's software has fundamentally altered the practice of medicine in the U.S. to the detriment of patients with a legitimate need for controlled prescription medications and the health care providers who treat such patients."

AI in Nursing: The Future Is Coming

The NarxCare Report isn't the only AI tool that can impact how healthcare providers and nurses care for patients — or make an impact in clinical practice today. For example, the University of Kansas health system is partnering with an AI company to cut time on note-taking by transcribing and summarizing relevant patient-clinician conversations.

Emory University's AI "patient" HAL S5301 gives students a lifelike nursing simulation experience by conveying a variety of symptoms and conversations.

While AI advances rapidly, it can't replace the discernment unique to human healthcare providers. Medical leaders tested ChatGPT's ability to diagnose, and it ultimately failed because it would at times provide false answers called "hallucinations."