Version 2022 PhysicianAPP Edition Trivia Question Does anyone know Miss America 2019s public initiative Mind Your Meds Drug Safety and Abuse Prevention from Pediatrics to Geriatrics ID: 1043464
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1. Welcome to Chronic Pain 2.0Version 2022Physician/APP Edition
2. Trivia Question:Does anyone know Miss America 2019’s public initiative? ’Mind Your Meds: Drug Safety and Abuse Prevention from Pediatrics to Geriatrics.’
3. She also did a science experiment for her talent- yay science! And yay to acknowledging the dangers of inappropriate medication usage/the opioid crisis.
4. Anyone know this guy? Kansas doctor gets life in prison for selling opioids that led to patient's death (CNN)He made the Medscape list of 10 Worst Physicians of 2019 (along with Dr. Galichia for doing inappropriate stents).
5. The Tough TruthEVERY day, more than 130 people in the U.S. die from opiate overdoseIt is estimated that 21-29% of patients prescribed opiates for chronic pain, misuse them8-12% develop an opiate use disorder80% of people who use heroin, first misused prescription opiates**https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
6. Where to even start…Establishing a patient on the chronic pain protocol (not previously on pain meds- prescribed here or elsewhere)Patient fills out CP Packet PRIOR to being seen for CP1Contents: records release form, pre-visit packet sheet, chronic pain patient information sheet, medical questionnaire, PHQ-9, SOAPP, CAGE-AID, brief pain inventory, Narcan information sheets (x2), controlled-substance agreement copyCP1 (40 min): review medical/pain specific history, first aegisCP2 (20 min/20 min BH): mental health focus, review SOAPP, CAGE-AID, BH to see patient as part of this visitCP3 (20 min/20 min pharmacy): go over controlled-substance agreement, discuss appropriate medication usage, optimally prescribe at this visit (but case dependent), pharmacy to discuss naloxone/video about usageAfter CP 1/2/3: loops in to general follow up, every 6 months, with aegis and substance agreement yearly.
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8. Release of Records Form
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11. Scoring of PHQ9:
12. Clinically, a score of 7 or higher will identify 91% of those who actually turn out to be at high risk. The Negative Predictive Values for a cutoff score of 7 is . 90, which means that most people who have a negative SOAPP® are likely at low-risk.
13. Item responses on the CAGE and CAGE-AID are scored 0 or 1, with a higher score indicating alcohol or drug use problems. A total score of 2 or greater is considered clinically significant, which then should lead the physician to ask more specific questions about frequency and quantity.
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19. When a Patient Becomes a part of the pain protocol… Pertinent Information will be put in the “Confidential Information” section (to be done by nursing)It should be kept up to date by nursing and providerInformation: CP 1: DateCP 2: DateCP 3: DateCP Reestablish: Date (omit CP1/2/3 if reestablish packet done)CPFU: Date (Due Date)Aegis: Date, Appropriate/InappropriateMEU: quantity, short/long acting amountsKTRAX/compliance: previous issues, irregularitiesOpiates and Benzos: Yes/No**prior to refills: check due date, KTRAX, scheduled appts(This template will be printed and available for all nursing staff)
20. Who needs to Re-establish? Any patient that has regularly been on opiates for 3 months continuously or 3 months out of the year. (CDC definition)Any amount of morphine equivalent units, Tramadol is included. Any patient that is new to our clinic, but has been on chronic pain medications prescribed elsewhere prior (see above 3 month rule). Outside of this- they either need to go through the CP1/2/3 protocol or are just a regular patientA person who meets criteria to ‘reestablish’ but would benefit from a more thorough process can ALWAYS go thru CP1/2/3. A person who is new to chronic pain CANNOT skip to the chronic pain reestablish visit.
21. Re-EstablishingWhy? We owe it to our patients to provide the most recent information on opiates and safely prescribe these medications with purposeful follow up. Have patient make a Re-Establishing Chronic Pain VisitCP Re-establish packet (doesn’t need to be filled out prior to visit, unlike CP1): chronic pain patient info, medical questionnaire, CAGE-AID, SOAPP, brief pain inventory, PHQ-9, Naloxone info, controlled-substance agreementOnce they have this one time visit, they are established on the ‘new’ chronic pain protocol (it gives them an opportunity to see the controlled substance agreement, etc)They need to follow up every 6 months for a chronic pain specific visit with aegis every year at least. (CPFU: brief pain inventory, phq-9, naloxone information, controlled substance agreement *yearly)
22. Chronic Pain Follow UpOnce every 6 months (aim for this, does not need to be to the exact day)Aegis every year (with provider autonomy, if it needs to be repeated sooner, then do it)– Point of Care Drug Testing COMING SOON! Chronic pain follow up packet: brief pain inventory, PHQ9, controlled-substance agreement (try to fully fill out yearly), Naloxone educationKeep ‘confidential information’ updated with aegis date, etcAll documents are scanned, nothing kept in files or sitting around.
23. They are established, following up, now what?!
24. Welcome to the Chronic Pain Committee10
25. Our Purpose…To review patients and their pain management when concerns arise from any member of the healthcare staff (we would love for team members to be present, when the patient is up for review)To teach safe tapering schedules, identifying and treating opiate use disorder and withdrawalTo educate more on Suboxone and increase interest in training YAY!Suboxone Agreement being added to Athena as we speak!To stay updated on new data in regards to opiate prescribing, other alternatives, etc
26. Questions or thoughts?