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TSWF Chronic Opioid Therapy (COT)
CPG AIM Form Training
AMSUS Lecture 30 Nov 2016
Sep-Dec 2016 Form Version
Objectives
• Introduce you to the documentation format
and content available to MHS providers and
staff right now!
• Demonstrate practical application of the
TSWF COT CPG AIM form
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What Do We Know About
documentation and
the Use of Opioid Analgesics for
Pain?
• Increased surveillance increases overall safety and decreases morbidity and
mortality in this patient population
• Increased surveillance is strongly recommended for chronic pain patients using
opioid analgesics due to the high risk of their misuse
• Increased surveillance cannot occur without consistent and standardized
documentation!!!
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How Will Using the COT Form
Help You Manage Your COT
Patients?
• Promote evidence-based management
• Identify critical decision points in management of
patients with chronic pain who are candidates for
opioid therapy
• Provide care congruent with local policies regarding
referrals or consultations with substance abuse
specialists
• Standardize treatment of COT patients across the
MHS
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What is Documented
in the COT Form?
• Sole care provider
• Pain Assessment using the DVPRS Scale
• Functional Pain Scale using the supplemental questions using the
DVPRS.
• Date, presence, and location of the Pain Care Agreement
• Acknowledgement of contraindications prior to initiation of COT
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What is Documented
in the COT Form?
• Appropriateness of referrals to specialists
• Documentation of date and results of Urine drug testing (UDT)
• Risk assessment using DIRE, ORT, etc.
• Past pain treatment history and results
• Evaluation of possible opioid side effects at each visit
• Comprehensive Care plan for your COT patient
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Reasons for and Methods of Increased
Monitoring
of COT Patients
The VA/DoD Clinical Practice Guideline (CPG)
recommendations for patients requiring increased
monitoring during Chronic Opioid Therapy (COT) are
at the top of the TSWF COT CPG AIM form
The CPG recommendations for
increased monitoring methods
are located at the top right of
the form
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DVPRS
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DVPRS
Supplemental Questions
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Documentation of DVPRS
Supplemental Questions
• Documenting the effect of pain on quality of life is essential to managing
pain levels
• The Defense and Veterans Pain Rating Scale and the associated
Supplemental Questions standardize and quantify the patient’s
responses for rating pain during the assessment
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Contraindications to COT
• Patients with contraindications are
NOT candidates for Opioid Therapy
and should be referred to specialty
care
• Contraindications are reviewed
with the patient during each visit
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Side Effects of COT
• Adverse effects of opioid
medications are manageable
elements for COT patients’
treatment plans and should be
reviewed during intake at each visit
• Providers should use clinical
judgment to manage side effects and
reactions
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Pain Care Agreement (PCA)
• The Pain Care Agreement is an annual requirement
• Document the date and location where the original agreement
can be obtained on the COT CPG form
• A link to an Example
Pain Care Agreement
is now included
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MTF Prescription Monitoring Program
https://www.express-scripts.com/TRICARE/tools/rxMonitoring.shtml
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MTF Rx Restriction Request Form
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COT Comprehensive Care Plan
(CCP)
Specific to COT Chronic Pain CCP
• Diagnosis
• Date therapy is initiated
• Sole prescribing provider
• Treatment regimen
• Baseline pain assessment
• Screening measures for COT
• and LBP
• Opioid Risk Tool & D.I.R.E.
• Date of last urine drug test
• Document pill count for
increased monitoring (as needed)
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Pain Treatment History
The Pain Treatment History is separate from the Medical Conditions
(PMHx) box, allowing additional text space for specific pain
treatments recommended in the VA/DoD CPG
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Behavioral Health
Treatment History
• The Behavioral Health History is separate from the PMHx
• Focused Behavioral Health History elements are identified in the
CPG clinical hints box for added support
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D.I.R.E. and ORT Screenings
(Form View)
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COT ® Reference Tabs
• The TSWF COT-CPG AIM form contains five reference tabs
(marked with a ®) with specific COT content from the
VA/DoD CPG
• Reference tabs use flow diagrams, tables, and external links
to guide providers through COT patient management
• COT-CPG reference tabs are included for guidance in
medication administration as well as numerous possible
drug-drug interactions
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Initial Assessment Tab
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Follow-Up Assessment Tab
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OT Discontinuation Tab
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Medication Guidance Tab
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Dug Interaction Tab
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TSWF Resource Material
The TSWF repository for training/educational
materials and updates:
www.tswf-mhs.com/
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Comments or Feedback
Contact
• Form feedback / discussion forums:
https://www.milsuite.mil/book/groups/tswf
• TSWF resources / educational materials:
www.tswf-mhs.com
• Local Clinical Systems Trainer (CST)
• COT Project Managers:
Mark Kline [email protected]
Scot Ario [email protected]
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TSWF Service Leads
 ARMY – Dr. Rolando Merino
 NAVY – CDR Anja Dabelic
 AIR FORCE – Maj Matthew Barnes & Maj Thomas Mahoney
TSWF Feedback
https://www.milsuite.mil/book/groups/tswf
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