Opioid Prescription Management Toolkits

Opioid Prescription Management Toolkit for Chronic Pain Sustainable Solutions for Vermont:
Practice Fast Track and Facilitators Toolkits

Connie van Eeghen, DrPH
Research Assistant Professor
Larner College of Medicine

Charles D. MacLean, MD
Associate Dean for Primary Care
Larner College of Medicine
Office of Primary Care

Amanda G. Kennedy, PharmD, BCPS
Director
The Vermont Academic Detailing Program
Larner College of Medicine
Office of Primary Care

What are these toolkits and why were they created?

These toolkits collect the best practice strategies for managing opioid prescriptions in primary care (and other) ambulatory settings. The strategies resulted from a two-year project (The Opioid Prescribing Quality Improvement Project, 2012-2014) to identify the most helpful methods used to create predictable and well-managed opioid prescribing patterns for physicians, nurse practitioners, and physician assistants and their patients.

What are some of the best practice strategies for managing opioid prescriptions?

New regulations about the prescribing of chronic opioids require the use of consent forms/treatment agreements and use of the prescription monitoring system. The standard of care supported by boards of medical practices across the country recommend, under certain circumstances, a variety of practice strategies to safely prescribe and monitor chronic opioid treatment. These strategies include assessing risk for misuse, use of pill counts and urine drug testing, best-practice documentation, and standardizing prescribing intervals to minimize communication issues among patient, office staff and prescriber, and others.

What are some of the results from the opioid prescribing two-year project?

All ten practices enrolled in the project reported positive results from the best practice strategies they chose to implement from the toolkit. The strategies helped prescribers standardize their approach and increase confidence in managing opioid prescriptions, helped practices change their support systems, and increased provider and staff satisfaction regarding the way opioid prescriptions are managed.

Who should read these toolkits and how are they different?

Fast Track Toolkit (second edition, September 2017): This toolkit is intended for ambulatory care practices whose leaders, providers, and staff want to improve the process of managing opioid prescriptions for their chronic pain, non-palliative care patients.   It is for practices with a team ready to make a quick start on a few of the 17 strategies and provides practical advice on getting started, how to adjust practice workflow, and how to implement changes.  The toolkit includes an extensive appendix with policies, sample tools, and references.  This toolkit has been updated in response to Vermont's new rules governing the prescribing of opioids for pain, effective July 1, 2017.

Facilitator Toolkit (second edition, September 2017): This toolkit is intended for practices that have not yet made a decision to work on opioid prescription management and need to develop a rationale, leadership support, and team to work on this topic.  It provides three stages of development: preparation, design (of workflow), and implementation.  It provides detailed guidance on measurement, team facilitation, work flow analysis, and follow up.  It is best used by facilitators, staff, or leaders interested in supporting a transformative change in opioid prescription management. It includes the same appendix as the Fast Track Toolkit, with additional materials to support facilitation.  This toolkit has been updated in response to Vermont's new rules governing the prescribing of opioids for pain, effective July 1, 2017.

Opioid Use in the Post-Operative Setting

The UVM Office of Primary Care and the Vermont Academic Detailing Program have focused on a variety of projects to better understand and improve the prescribing of opioids in primary care, specialty care, and dentistry. “Right-sizing” the amount of opioids prescribed is an important strategy to reduce the likelihood for opioid diversion or misuse. Quarterly reports from the Department of Health have shown consistent gradual reductions in opioid prescribing: http://www.healthvermont.gov/alcohol-drugs/reports/data-and-reports.

We’ve created two educational handouts, one directed at patients, and the other at surgeons and their staff, regarding opioid use in the post-operative setting. They include web links to brief educational videos. These materials were based on research projects in the Department of Surgery at the UVM Medical Center and elsewhere and emphasize that historically prescribers have, on average, been prescribing higher volume of opioids than many people require.

Please share these materials and video links with patients, colleagues, and staff:

Tips for Safe Opioid Prescribing after Surgery
Video Resource for Safe Opioid Prescribing after Surgery

Tips for Safely Taking Prescribed Opioid Pain Medicine
Video Resource for Safely Taking Prescribed Opioid Pain Medicine

This public health project (03420-A181305) is in collaboration with the Vermont Department of Health, Division of Alcohol and Drug Abuse Programs, with funding from federal Centers for Disease Control and Prevention (CDC).

References:
Fujii et al 2018. DOI: https://doi.org/10.1016/j.jamcollsurg.2018.01.058
MacLean et al 2018. https://doi.org/10.1093/pm/pny215

Image of Improving Opioid Prescribing Manual for Physician Practice

Improving Opioid Prescribing Toolkit (second edition) - Practice Fast Track (PDF)

Image of Improving Opioid Prescribing Facilitator Manual

Improving Opioid Prescribing Toolkit (second edition) - Facilitator Manual (PDF)

Video Resources

Not all web browsers provide optimal viewing of videos.  We recommend Internet Explorer to view the following videos:

Video 1Downloading annual data from the Vermont Prescription Monitoring System
This six-minute video describes how to download VPMS prescribing data for a single prescriber covering a date range.

Video 2Combining VPMS data to create an Annual Practice-level Profile
This five-minute video describes how to combine annual prescribing data from multiple prescribers in a practice, and then anonymize it for further analysis, including by an analyst from outside the practice.