Step 2Assess Current Approach to Opioids and Identify Areas for Improvement
“[Registry Manager] did a list of patients for each clinician and calculated all of their Morphine Milligram Equivalents (MMEs). She showed it to them and the clinicians were very competitive.”
Assess current policies and practices
Begin by assessing your current policies and practices for opioid prescribing. Are your policies well documented? Do they cover all the key aspects of opioid use? How well are the policies communicated to prescribers and their team? Are prescribers consistently following the policies? Even when policies exist, there can be wide variation in how prescribers treat patients on opioids. In some cases this is a result of prescribers inheriting patients already on opioids, but can also result from no consistent policies. To more systematically assess what are current practices, your system could survey or interview clinicians about gaps in care or issues they encounter, even ask questions at a staff meeting. You might also convene clinicians to discuss and reflect on key questions (e.g., “Do our current policies adequately address the issues that come up with patients on opioids?”). Finally, often sharing patient stories can illuminate the challenges with opioids and motivate staff for a QI effort.
Complete the self-assessment questionnaire
Complete the self-assessment questionnaire (Appendix A) to determine your system’s current status on steps in the QI effort and with specific Guideline recommendations (see Step 4). Ideally, the assessment should be completed as a team (i.e., implementation team including leadership) or at least by multiple individuals from across the health care system or practices that are involved in prescribing opioids. Additionally, it is important to include different members of the care team, since perspectives might differ depending on one’s position. The self-assessment is also a useful tool for getting team members on the same page.
Collect data on your patient population on opioid therapy
Some basic patient population information is needed to help guide the QI implementation. How many patients are on long term opioid therapy? How many patients are prescribed opioids? While it is not necessary at this stage to be exhaustive, you will want to collect sufficient data to help you decide on your system goals (see Step 3). You might consider pulling the denominators for the QI measures (see Step 5). For this QI initiative, your EHR will be an essential tool. As mentioned in Step 1, it is a good idea to include the EHR IT staff as members of your implementation team.
Determine access to specialists and other resources
Determine which specialists and other resources your practice does or does not have available within the system or in the community. This may include access to laboratory services, behavioral health specialists, pain management specialists, addiction specialists, interventionists, alternative therapy providers, buprenorphine waivered clinicians, etc.
Identify areas to improve upon
Based on your assessment results, you will likely identify areas for improvement in your policies, prescribing practices, workflows, and resources needed to support care of patients with chronic pain or on long-term opioid therapy. Additionally, the results of your assessment may highlight to clinicians and leaders alike the extent of unsafe practices with opioids (e.g., high dosages) in your system.
Self-Assessment for Step 2
|Assess current approach and identify areas for improvement||1||2||3||4|
|Assess current approach to opioids and pain management, and identify areas for improvement||No assessment has been done.||Begun assessment of current policies and practice. Begun self-assessment.||Begun collecting data on patient population on opioids and access to specialist.||Completed self-assessment. Identified areas for improvement.|