American Society of Regional Anesthesia and Pain Medicine February 2018 - 22

Figure 2: Nearly the same percentage of patients with and without
opioid prescriptions had charts noting prior histories of substance abuse.
They were also equally likely to have positive urine toxicology screenings
for cocaine during the current admission. A total of 66% of patients with
opioid prescriptions, of which 19% also had histories of substance abuse,
had received no urine drug screening in the 12 months prior to their ED
admission.

guidelines. Both institutions worked with EPIC system team
builders to create an opioid registry and an opioid dashboard/
pain navigator. The registry contains all patients with ICD-10
diagnosis for chronic pain, and it will be used to feed our opioid
dashboard/pain navigator (Figure 3) for monitoring UDS, controlled
substance agreements, and concomitant use of illicit substances,
benzodiazepines, or alcohol.
To establish a baseline assessment, we identified all chronic pain
patients in our ambulatory clinics at PHS. Patients were identified
by ICD-10 code while excluding those with cancer pain. Patients
with chronic pain diagnosis represented 37% of our ambulatory
patient population, of which 9.4% are on chronic opioids (Table).

opioids, reduces opioid adverse effects, and improves patient
outcomes.
Both institutions furnished an opioid policy detailing the
requirements that ensure adherence to the CDC and TMB

Prior to our education implementation, we assessed the
percentage of patients with completed opioid agreement/consent
signed, risk assessment tools documented on file, UDS over the
past 12 months, suicide risk screen assessment, and history of
drug and alcohol abuse. We found that the majority of patients had
a suicide risk assessment on file (91.6%), whereas only a quarter
of the ambulatory chronic pain patients on opioids had a UDS
within the past 12 months, despite 16.6% having a history of illicit
drug use and 25.9% having a documented history of alcohol abuse
(Table). An understanding for the need and the value of opioid
abuse risk assessment tools was lacking, as reflected by the low
percentage (1.6%) of patients having an opioid risk assessment
tool or addiction behavioral checklist completed on record. Our
goal is at least 90% compliance in all fields when reassessed in
12 months.

Figure 3: Opioid dashboard/pain navigator. ©2017 Epic Systems Corporation. Used with permission.

22

American Society of Regional Anesthesia and Pain Medicine
2018



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