Improving Compliance with Best Practice Standards for Patients at Risk for Opioid Use Disorder

Background: Available literature suggests that provider adherence to best practice guidelines regarding the prescribing and management of opioid therapies is low. Documentation of patient screening for present or future opioid use disorder is inconsistent. Provider incorporation of evidence-based guidelines into routine patient care is essential to optimizing outcomes related to opioid use disorders. Purpose/Specific Aims: The purpose of this scholarly project was to facilitate recognition of patients at high risk for opioid use disorders and facilitate best evidence based practices in the care of this population. Specific aims were to achieve provider compliance with: patient risk screening, PDMP review, completion of signed care plans, and reduction of inappropriate opioid prescriptions. Methods: A quasi-experimental design was used for this quality improvement project. The sample included patients receiving treatment for acute or chronic pain, or who were identified as having a substance use disorder. The project was conducted at an internal medicine practice in the northeast region. The intervention included an educational program addressing the ASAM guidelines and ORT utilization with implementation of a SmartPhrase in Epic. Baseline data was collected for the two-month period preceding the intervention and post-intervention data was collected for the three-month period following the intervention. Differences in pre- and post- intervention results were analyzed using chi square. Results: This project resulted in improved compliance with the implementation of urine toxicology screening, PDMP review, and completion of a controlled substance agreement. Compliance with ORT was not achieved. Conclusion: This project led to an increase in compliance with best opioid prescribing practices. The ORT was not consistently implemented; however, the number of new opioid prescriptions remained negligible. Additional efforts will be necessary to maintain the progress achieved in this project including attention to continued provider education. Real-time auditing and feedback will also be incorporated, and opportunities to involve office staff will be explored