Six Building Blocks to Guide Management of Chronic Opioid Therapy
| Building Block | Description | Examples of Action Steps |
|---|---|---|
| 1. Provide Leadership Support | Leadership can build organization-wide consensus to prioritize safe, more selective, and more cautious opioid prescribing | Identify clinical champions to spearhead COT practice change initiatives. |
| Provide protected time and space for providers and staff to discuss and agree upon short and long-term goals for COT practice change initiatives | ||
| 2. Revise Policies, Patient Agreements and Workflows | Revise and implement clinic policies and define standard work for health care team members to achieve safer opioid prescribing and COT management in each clinical contact with COT patients. | Convene a team from each area of the clinic to revise existing policies or write new ones |
| Review patient agreement and revise to ensure alignment with clinic policies. | ||
| Discuss with all staff and clinicians and modify roles, responsibilities and workflows accordingly | ||
| 3. Implement a Registry for Population Management | Implement pro-active population management before, during, and between clinic visits of all COT patients to ensure that care is safe and appropriate and provide measure to track COT improvement activities. | Enter all existing COT patients and their relevant enrollment data into a COT registry. |
| Assign each COT patient to a single provider responsible for managing their opioid use and. | ||
| Assign a team member in each clinic with responsibility and protected time for managing and updating the registry. | ||
| Use the registry to track data for prescription management (e.g., COT dose, PEG scores to monitor function and pain, date of state prescription database checks) | ||
| 4. Conduct Planned Patient-Centered Visits | Conduct pre-visit planning and support patient-centered, empathic communication for COT patient care. | Review COT registry reports prior to the visit to identify care gaps |
| Monitor and adjust management based on function and quality of life rather than pain scores (the PEG scale) | ||
| Offer organizational support for clinic staff and providers to preview charts and do team huddles about COT patients | ||
| Support staff training, to encourage the use of empathic communication techniques that | ||
| 5. Identify Resources for Complex Patients | Develop resources to ensure that patients who develop complex opioid dependence, are identified and provided with appropriate care | Identify addiction referral resources and other mental/behavioral health resources, and ensure they are readily available, setting-up referral protocols or agreements as necessary. |
| 6. Measure Progress | Continuously monitor progress and improve with experience. | Identify key process and outcome measures to monitor practice change implementation. |
| Monitor agreed upon COT patient care data, providing and discussing data with clinic staff and medical providers at monthly meetings. |
COT, chronic opioid therapy.