Opioid Prescription Management Toolkits
Opioid Prescription Management Toolkit for Chronic Pain Sustainable Solutions for Vermont:
Clinic Workbook
Connie van Eeghen, DrPH
Research Assistant Professor
Larner College of Medicine
Charles D. MacLean, MD
Associate Dean for Primary Care
Larner College of Medicine
Office of Primary Care
Amanda G. Kennedy, PharmD, BCPS
Director
The Vermont Academic Detailing Program
Larner College of Medicine
Office of Primary Care
What is this toolkit all about and why was it created?
This toolkit provides the best practice strategies for managing opioid prescriptions in primary care (and other) ambulatory settings. The strategies resulted from a two-year project (The Opioid Prescribing Quality Improvement Project, 2012-2014) to identify the most helpful methods used to create predictable and well-managed opioid prescribing patterns for physicians, nurse practitioners, and physician assistants and their patients. This workbook has been updated in response to Vermont's new rules governing the prescribing of opioids for pain, effective July 1, 2017 and new publications on effective prescribing in 2018.
What are some of the best practice strategies for managing opioid prescriptions?
Past regulations about the prescribing of chronic opioids require the use of consent forms/treatment agreements and use of the prescription monitoring system. The standard of care supported by boards of medical practices across the country recommend, under certain circumstances, a variety of practice strategies to safely prescribe and monitor chronic opioid treatment. These updated strategies include practice-wide prescribing philosophies and methods, assessing risk for misuse, use of pill counts and urine drug testing, best-practice documentation, and standardizing prescribing intervals to minimize communication issues among patient, office staff and prescriber, and others.
What are some of the results from past opioid prescribing projects?
The original ten primary care and specialty practices enrolled in the project reported positive results from the best practice strategies they chose to implement from the toolkit. The strategies helped prescribers standardize their approach and increase confidence in managing opioid prescriptions, helped practices change their support systems, and increased provider and staff satisfaction regarding the way opioid prescriptions are managed. These results have been repeated in subsequent projects with a variety of ambulatory practices.
Who should read this toolkit?
Clinic Workbook (third edition, September 2019): This toolkit is intended for any practice member with an interest in supporting a practice that is developing a goal to work on opioid prescription management using a standard "quality improvement" approach. It provides three stages of development: preparation, design (of workflow), and implementation. It provides detailed guidance on measurement, team facilitation, work flow analysis, and follow up. It can be used by any practice member interested in supporting a transformative change in opioid prescription management.
References:
Fujii et al 2018. DOI: https://doi.org/10.1016/j.jamcollsurg.2018.01.058
MacLean et al 2018. https://doi.org/10.1093/pm/pny215