Implementation Phases

6 Building Blocks Implementation for Pain Management & Opioid Prescribing

Project Initiation Phase

The project initiation tasks are crucial to the success of the initiative.

Complete 6BB Pre-Assessment Provider and Staff Survey

We recommend that you start by having all providers and staff complete the Six Building Block Assessment. This survey reveals the perspectives of everyone in the clinic. The results will vary significantly from person to person. These differences help guide the discussion and future decisions on what areas require more focus and improvement.

We provide two versions of the Six Building Block assessment:

  1. Six Building Block Assessment – Abbreviated Workshop Version   We have simplified the scoring and eliminated more detailed guidance.  You should use this version for the preliminary staff survey.  Completing this simplified version will take less than an hour.
  2. Six Building Block Assessment – Full Version for Implementation Teams   This version has more detailed implementation guidance on the four levels of each measure.

Select the Implementation Team

The implementation team ideally would have members who can represent the different functions within the clinic. Clearly the providers need to lead any change initiative. Yet, with any change improvement initiative, all roles and functions are likely to be involved in the solution.

Medical Director/Clinical Champion EHR/IT Support
Providers Medical Assistant
Clinic Manager Front Desk

We recommend that the implementation team meet at least monthly. Ideally these would not be new meetings, but an agenda item added to an existing, relevant meeting.

Review & discuss Six Building Block Pre-Assessment

One of the first tasks of the implementation team is to have all providers and staff complete the pre-assessment survey and to review the results. This analysis will typically reveal gaps on the practice such as a lack of policies in some areas. It will also reveal the differences in perception of the clinic providers and staff. From this review, the implementation team should be able to identify high priority areas where change is needed.

Kickoff Meeting – All Providers & Staff

The meeting is led by the medical director and/or clinical champion. The agenda includes:

  • What is the opioid problem? Why is out clinic undertaking this initiative? Present some state statistics, review the state activities.
  • The implementation team presents a high level overview of staff survey results.
  • We recommend having a pharmacist from CCO attend who would present clinic and regional prescribing data.
  • The medical director/clinic champion would present high level goals for the clinic.

Discuss and revise pre-assessment & agree on 6BB baseline scores

The pre-assessment staff survey is not likely to be an accurate picture of the clinic.  The implementation team needs to re-do the assessment to create a clinic assessment baseline that can be used to compare progress as the clinic implements changes and improvements.

Set goals & develop project work plan

We recommend that the implementation team review the gaps and prioritize which practice areas to focus on first.  The result will be a plan with assigned tasks and schedules.

Implementation Activities

Implementation team meets monthly

It is best if the monthly meetings are incorporated into existing clinic meetings as a constant agenda item.

Create and/or update policies

Building Block # 2 – Policies has a set of recommended policies that meet the CDC opioid prescribing guidelines.

Develop a way to track patients on opioids

Identifying and tracking patients on chronic opioid therapy can be challenging.Ideally, the EHR can generate lists of patients on opioids long term.  Your clinic administrator and the IT support staff should able to help. If the EHR cannot easily generate the patient lists you need, we recommend that you consider simple alternatives, such as a spreadsheet this is updated each month.  This regular tracking is essential to determine whether your clinic efforts are successful with this patient population. See Building Block #3 – Tracking Patients on Opioids for more details.

All prescribers check the PDMP (Prescription Drug Monitoring Program) regularly

On March 27, the Oregon state legislature passed HB 4143.  As part of this bill, all prescribers are now required to register on the PDMP.  Learn how to register and how to use the PDMP.

Identify knowledge and skills gaps and setup an education plan

Arrange for behavioral health and MAT

Access external expertise and resources

Decide what measures to track and set up tracking system


Monitor and Sustain Activities

  • Leadership and implementation team review progress towards goals
  • Reports on measures are produced & reviewed monthly
  • Update policies as needed
  • Review patient registry monthly
  • Setup a continuous quality improvement process