American Society of Regional Anesthesia and Pain Medicine February 2018 - 23

Table: Results of baseline assessment in ambulatory clinics.
Baseline data
Total ambulatory patients

Numerator

Denominator

Percentage

Short-acting opioid only

2,151

23,786

Long-acting opioid only

23,786

0.2%

23,786

0.2%

Consent signed

379

2,242

16.9%

ORT/ABC baseline

2,242

1.6%

Urine drug screening

570

2,242

25%

Suicide risk screening

2,054

2,242

91.6%

Illicit drug abuse diagnosis

272

2,242

16.6%

Alcohol abuse diagnosis

581

2,242

25.9%

Short- and long-acting opioid
Ambulatory patients on opioids

a
Numerator represents all patients with chronic pain who are on chronic opioids. Denominator represents patients
who have a diagnosis for chronic pain (ICD-10): 23,786, which represents 37% of our ambulatory population.
b
Numerator represents the following categories: opioid consent/agreement completed, urine toxicology screen
in past 12 months, suicide risk assessment, history of drug abuse, history of alcohol abuse. Denominator
represents all patients with chronic pain who are on chronic opioids.

Several breakout workgroups targeted different areas pertaining to
opioid safety. Areas with significant progress include:
1. Education to providers on the chronic opioid practice policy
and CDC and TMB regulations. The educational process on
campus is an ongoing effort, with our target audience starting
with medical students. Quarterly lectures focus on nonopioids,
coanalgesics, nonpharmacologic options, equianalgesic dosing
of opioids, interpretation of UDS, and interesting case scenario
presentations.
2. EPIC embedded smart phrases for the documentation of
the new mandated requirements. Such phrases facilitate
documentation and ease the process of prescribing in high-flow,
busy primary care clinics.
3. Designing an opioid dashboard/pain navigator, which includes
an informed consent and opioid agreement, UDS, and opioid risk
assessment tool or addiction behavioral checklist.
4. Collaboration with other institutions nationwide through
participation with Centers for Medicare and Medicaid Services,
transforming clinical practice networks through collaborative
projects, thus sharing our experience.
5. The toxicology workgroup is standardizing toxicology essays
among all three teaching hospitals and re-evaluating toxicology
order sets to unify, simplify, and ensure cost effectiveness.

6. The addiction workgroup is increasing patient access to
medication-assisted treatment and increasing the number
of providers who are buprenorphine licensed by providing
certification classes on campus.
CONCLUSION
Confronting the opioid epidemic is a large undertaking that requires
a multidisciplinary team approach and a system-wide change
to ensure a meaningful impact. The new prescribing regulatory
requirements place an increased burden on prescribers who are
at higher risk for frustration and burnout. An integral part of the
solution lies in using EMRs, thereby facilitating and standardizing
documentation and simplifying opioid prescription practices while
improving monitoring.
REFERENCES
1.

Crane EH. Highlights of the 2011 Drug Abuse Warning Network (DAWN) findings
on drug-related emergency department visits. Updated February 18, 2013.
https://www.samhsa.gov/data/sites/default/files/DAWN127/DAWN127/sr127DAWN-highlights.htm. Accessed December 16, 2017.

Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved
overdose deaths-United States, 2010-2015. MMWR Morb Mortal Wkly Rep.
2016;65(5051):1445-1452.

Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for
chronic pain-United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49.

American Society of Regional Anesthesia and Pain Medicine
2018

https://www.samhsa.gov/data/sites/default/files/DAWN127/DAWN127/sr127-DAWN-highlights.htm https://www.samhsa.gov/data/sites/default/files/DAWN127/DAWN127/sr127-DAWN-highlights.htm

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine February 2018