Pain / Opiates Workgroup
WCMS Committee for Responsible Opioid Prescribing: Education Packet (2007)
Whatcom County Pharmacists Association Drug Alert (contact Tony Dickerson, Custom Rx Shoppe, adickerson@crxshoppe.com 685-4242)
Reprints of four articles/guidelines on opioid prescribing, several of which have been updated since 2008 when the booklet was distributed:
Pain Summit 9-13-10
Large flip chart notes
Ideas-do no harm
- Pain Clinic-chronic
- Resources for coping skills
- Pharmacy Coordination-monitoring program-ePerscribing, sharing information on treatment
- Multidisciplinary support-adjunctive therapy
- Need Education on how to share information
- Share Problem list
- Broaden group to include-law enforcement, pharmacy, payors
- Need accountability for physicians and patients
- Community standards of care
- Appropriate handoffs post surgery
- Driving requirements, return to work issues
- Policies take pressures off individual providers-a voice
- Hospital supported resource (could reduce hospitalizations-IV drug abuse treatments)
- Change models of payments-need to lobby state legislature
- Education on pain management
- Informed consent-PH Eugene is using this for goal setting
- Ensure use of best practice care-ACOG paper
- Support for providers who appear to be high prescribers
- are they aware of the standards,
- what help do they need
- CME opportunities
- Quarterly M&M related to OD cases
Problems:
- Over prescribing providers-benzos as well as opiods (Chem dep)
- Is it Primary Care or Specialty Care:?
- Identify outlier physician groups (Dentists and orthopedics)
- Pts missing positive outlooks (nothing to look forward to)
- Communication between providers
- Patients without primary care providers-use the ED and specialists
- Mental health medications-not used as intended-related to payment from DSHS
- Passing off patients without knowing where to send them
- Ability to get a hold of physicians for Chem Dep patients
Constraints:
- HIPPA
- Information sharing
- Access-supporting care-community support
- Lack of treatment centers-where do you refer to?
- Healthcare Dollars
- Reimbursement system
Resources
- State Guidelines (Tony’s document)
- Patient centered approach
- Primary care guidelines
- Instructive
Need information repository
- Hold standards
- Hold monitoring data
- Educational information
Not a onetime deal-continuous push-what is the structure to support
Medical Society web page-link to Health Department page
Monitoring
- What are the indicators (# of patients, # of prescriptions)
- How will we know we are fixing the problem
- What is the question to answer
- We need to be sure to spread the data-share the information
- Indicators may direct us to the right interventions
Ideas of indicators:
- # of OD deaths
- % of students using drugs (Healthy Youth Survey)
- Admissions to social detox
- DAWN-national network relative to drug abuse
- Hospital data (Vince)-ODs
- ED data
- Days in neonatal dependence
- ED data
- Discharge meds
- Utilization of community standards (when developed)
- Provider surveys
- Quality of life survey
- Water quality data (!)
- GIS opiod use (!)
Sources-look for best practice-is there data already identified that others are looking at
- Kaiser
- VA
- Mayo
- Spokane county
- Law enforcement
Subgroups
Standards:
- Informed consent
- Standards of practice
- Voice of Public Health and Whatcom County Medical Society
- Privacy-release of information
- Handoffs post op care
- Link to meaningful use criteria-could be a way to get dollars
- Start with pain management, information sharing, include mental health and chemical dependency
Education
- CME
- M&M
- Spread standards-best practice
- Share data
- Sharing information-HIPPA
Advocacy
Community organizing
Subgroups:
M&M/Grand Rounds:
- Gary Goldfogel
- Joe Z
- Ken Bachenberg
- Barb Bachman
Education:
- Danielle Kizer
- Sarah Wells
- Adam Kartman
- Steven Wagoner
Standards (Informed Consent)
- Tony Gargano
- Tracy Quillette
- Brent Richardson
- Ken Bachenberg
- Steven Wagoner
- Barb Bachman
Behavioral Health/CD:
- Danielle Kizer
- Jackie
- Vince Foster
Indicators:
- Vince/Joni (AST Support)
- Diana Meyers
- Public Health?
Leadership:
- Greg Stern
- Tony Gargano
- Ione Adams
- Marcy Hipskind
- Barb Bachman
- Paul Sarvasy
- Barb Finkbonner
Sharing Info (Legally/Hippa Compliant) PMP
- Vince Foster
- Todd Guiton
- Adam Kartman
- Emily Gibson
- Mark Pearson
- Lori Nichols
Recommendations-end comments
- Use small groups to discuss issues-use one voice e-mail to larger group
- Publish the leader for each sub group
- Defined time frames for work to be complete
- Large group to meet again (Plenary)-6 month max-will be determined by small work groups