Building Block #2

Produce/revise policies, workflows, treatment agreements, and patient education materials

The organization’s goals need to be supported by corresponding policies (“What”) and associated workflows (“How”). Patient education is an essential component that explains how these clinic policies ensure patient safety and promote improved quality of life. The treatment agreement is a key part of patient education.

Acute Opioid Prescribing Policies (CDC #6, #7) 1234 Describe briefly what your clinic is currently doing.
Opioid prescribing policies for acute pain treatment are defined, incorporating the key CDC guidance:  utilizing immediate-release opioids, lowest effective dose, and for no longer than 3- 7 days without justification or re-evaluation.  Non-opioid modalities are encouraged and promoted.
Chronic Opioid Prescribing Policies (CDC #4, #5, #8) 1234 Describe briefly what your clinic is currently doing.
Opioid prescribing policies for chronic pain treatment are in keeping with the CDC guidelines, including duration (opioids for 90 days or greater) and dose, (< 50 MED, rarely more than 90 MED).
Non-opioid and Non-pharmacological Therapies (CDC #1) 1234 Describe briefly what your clinic is currently doing.
Non-opioid and non-pharmacological therapies for pain (acute and chronic) are used as first line treatment.  The organization works with payers to streamline authorization procedures for non-opioid and non-pharmacological therapies.  Lifestyle changes, such as better sleep habits, are recommended.
Co-Prescribing Benzodiazepines (CDC #11) 1234 Describe briefly what your clinic is currently doing.
Organizational policies discourage co-prescribing of opioids and benzodiazepines (or other medications such as z-drugs, carisoprodol, etc.) Existing patients on both are being tapered to safe levels defined in the policies.  Behavioral health or psychiatric consultations are made where indicated.
Urine Drug Screening (CDC #10) 1234 Describe briefly what your clinic is currently doing.
Urine drug screening is used for all patients on opioids at regular intervals as defined in the policy.  Actions for positive screens are defined and followed.
PDMP (CDC #9) 1234 Describe briefly what your clinic is currently doing.
The organization has clear policy on consulting the PDMP for every new controlled substance prescription and periodically (as needed and at a minimum defined time by the organization) for continuing prescriptions. All prescribers of controlled substances have registered with the PDMP.
Treatment Agreements (CDC #2) 1234 Describe briefly what your clinic is currently doing.
Treatment agreements are signed by every patient on opioids.  They are a key component of patient education about opioid risks and clear patient responsibilities. Both patient and provider expectations are delineated in keeping with clinic policies. The OMB requires the Material Risk form to be completed on all patients receiving chronic opioid therapy. This is a separate form and should be attached to ALL patient treatment agreements.
Patient Education (CDC #2, #3) 1234 Describe briefly what your clinic is currently doing.
Providers continue to educate their patients through conversations and education materials – the differences between acute and chronic pain, the risks of opioids, the benefits of non-opioid therapies and patients’ engagement in their own recovery.  Patients are encouraged to participate in treatment decisions and to set their personal goals.
Tapering (CDC #5, #7) 1234 Describe briefly what your clinic is currently doing.
The clinic has a standardized definition and tapering policy for high risk Chronic Opioid patients: Dose > 90 MED, documented aberrancy, unsafe co-prescribing, overdose, unapproved multiple prescribers, an inconsistent +/- UDS, or credible concerns for diversion by family, community, pharmacy, or police. Buprenorphine is available for patients who are identified as having OUD.
Naloxone (CDC #8) 1234 Describe briefly what your clinic is currently doing.
All patients receiving opioids (>50 MED), as well as those with opioid use disorder, should have naloxone prescribing offered to a close associate of the patient as part of the treatment plan. Co-prescribing is encouraged at lower doses, especially when co-existing risks, such as chronic pulmonary disease, are present. This is at the discretion of the provider or in consort with more stringent regional/organizational goals.
Buprenorphine (CDC #12) 1234 Describe briefly what your clinic is currently doing.
Clinic has buprenorphine treatment readily available to provide continuity of care when opioid use disorder is identified. All clinic staff are trained to understand SUD. The organization creates incentives and supports providers to obtain their X waver. If additional resources are needed, clinic works with community partners to provide buprenorphine for appropriate patients.