Transcript Responsible Pain Management Highlighting New Regulations of

Responsible Pain
Management
Implementing Regulations of
Indiana’s Medical Licensing Board
and Best Practices for Patient Care
Kimberly Sharp BSN,RN-BC
Chronic Pain Nurse Navigator
Franciscan St. Francis Health
Goals and Objectives
Review new Indiana laws for opioid
prescribing
Outline office implementation of best
practices and compliance monitoring
“First Do No Harm”
Indiana’s Safe
Prescribing
Recommendations
Healthcare Provider Toolbox:
http://bitterpill.in.gov/
A comprehensive
“Clinical Resource” to assist
you in managing your patients
with chronic pain
A starting point for you and
your staff
Toolkit - Format
 Not a dissertation; “designed for the busy
doc”
 Designed to be easy to read
 Provides links to resources/tools
 Provides templates for various surveys &
forms
 Links to websites with more in-depth
information for you and your patients
 Talking points for difficult conversations
A number of topics
to choose from to
assist you in
coming into
compliance with
recommendations
and rules
Key Stat
To engage
Overview
Has a bit more depth than
the recommendations and
includes links to forms,
additional info, etc
Specific
Recommendations
Just the facts ma’am
Includes
“Talking Points”
• Conversation
starters with
patients
• In the margins are
testimonials and
other useful info
The NEW Medical Licensing
Rules
The MLB rules take effect on
December 15, 2013 and apply to:
 Any patient taking >60 opioid pills
per month for ≥ 3 months
 Any patient taking a morphine
equivalent dose (MED) of >15 mg
for ≥ 3 months
Physician Shall Do…
but
it takes a Team to
achieve
Challenges to Adoption of
Opiate Guidelines





Lack of Time
Lack of knowledge
Patient expectations
Decreased patient satisfaction
Strained physician-patient
relationship
 Beliefs that opioids are safe
 Physician belief that this change is
not necessary
Optimize Workflow
 Develop policies and protocols
 Educate office staff
 Scheduling
 All persistent pain patient’s on
same day
 Allow additional time on first visit
to complete screening and
agreements
 Two visit process in the beginning
 Signage
 Documentation templates
Policies
 Prescription Policies
 Should be consistent among all
providers
 Refill policy
 After hours
 Missed appointments
 Pill counts
 Things to consider
 Will you prescribe on first visit?
 How to handle “lost scripts” or stolen
medications
 How to handle “Benzo’s”
Policies
 Compliance Testing Policy
 Urine Drug Screen
 Frequency
 Beginning January 2015 at least
annually
 Circumstances in which you will
re-monitor
 Consequences




Unable to void
“No show” if called in
Presence of alcohol
Presence of illicit drugs
Policies
 Compliance Testing Policy
 Urine Drug Screen
 Process
 Referring to lab outside of office
 In office
 Environment
 Identified staff
 Better data collection up front
leads to less question about
results
Policies
 Inspect
 How often
 At least initial and annually
thereafter
 Designated staff to run query
 Discharge Policy
 Must be consistency among all
providers
Treatment Agreement
 Communication to your patient of your
policies
 Provides information and education to
the patient
 Can be presented by your staff in detail
but
 The physician and patient shall review
and sign a “Treatment Agreement”
Risk Stratification
 2 Areas required
 Mental Health Assessment
 Risk for substance abuse
 Can be completed by staff or
patient and reviewed by
physician
 Examples in the online
toolbox
Educate Staff
• Overview of the regulations
• Office policy and protocols
• Scripting on how to introduce Treatment
Agreements and policies
• Emphasize this is all about keeping your
patients safe -- not judging or being
critical
• Conflict management strategies
Educate Patients




Letter
Policy
Signage
Framed around safety to
them, their family and their
community
Documentation
• Forms
– Informed Consent/Controlled Substance
Agreement
– Behavioral Health Screening tool (s)
– Substance Abuse Screening tool(s)
– Treatment Plan Templates for Providers
Documentation
• Electronic Medical Record
– Code or identifier for chronic opioid patient
– Code or identifier if “no longer prescribing
opioids”
– Program prompts
• No INSPECT/UDS in 6 months
• Trigger if no appointment in 3.8months
– Template or checklist format that includes
all aspects of MLB rules
Toolbox
Includes resources for
implementation:
Screening tools
Templates
FAQs
Drug Information
Primer on Urine Drug Monitoring
Changing the Paradigm
 Need to begin educating public about the
new rules and recommendations for
physicians and the impact on healthcare
delivery.
 Focus is on functionality as well as pain
control.
 Resetting expectations of the public – they
will need to be more actively engaged in their
treatment.
Summary
 Preserve and emphasize patient safety first
and foremost.
 Policies and protocols provide structure
 Education
 Staff
 Patients
 Public
 Team approach makes a difference!
It takes preparation and a little
time