Objectives
- 1.Describe the health system related causes leading to misses or near misses related to opioid prescriptions in palliative care clinic.
- 2.Identify current methods of practice by which opioid refills are requested by patients.
- 3.Describe a standardized tool to track opioid prescriptions and anticipate opioid refill requests.
Background
There is a paucity of data evaluating systems for management of opioid medications in the palliative care clinic population, which is unique due to changing symptoms and prognoses. At the Durham Veterans Administration (VA) palliative care clinic, there is no standardized system for opioid tracking or refill requests. This leads to redundant refill requests and missed or late opioid refills that can have adverse patient outcomes.
Aim Statement
To develop a centralized tool to aid outpatient palliative care providers track and manage patients on opioid medications.
Methods
A dashboard was developed to track opioid prescriptions and anticipate refills. This dashboard includes palliative care patients and their recent opioid prescriptions, medication doses, and date of fill, prioritized by anticipated refill dates. The dashboard is reviewed weekly and patients with appropriate monthly medications are prescribed refills. We followed opioid refill requests and adverse events such as withdrawal, overdoses, and acute pain crises pre- and post-intervention implementation.
Results
The Durham VA outpatient palliative care clinic sees approximately 740 clinic visits annually. Pre-dashboard implementation revealed a weekly average of 23.6 (SD 9.2) opioid refill requests. Several patients requested opioid refills after the medications had run out and 1 patient was seen in the ED for pain crisis. Two weeks after dashboard implementation, refill requests were reduced by 1/3. The dashboard identified 3 patients due for refills without a refill request and four patients that were lost to follow up.
Conclusions and Implications
This opioid prescription dashboard fills the gap for palliative care providers to keep track of opioid medications in large patient panels and minimize adverse outcomes for an already vulnerable population when opioid prescriptions are missed or delayed. Optimization of this dashboard may promote potential use at other VA sites and consideration for developing a similar mechanism in the private sector.
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Copyright
© 2021 Published by Elsevier Inc.
