With opioid-related complications such as addiction and overdose at crisis levels nationwide, a team at UW Health Belleville Family Medicine has made great strides to ensure that opioid prescribing practices are as safe as possible for their clinic patients.

Their efforts have earned them a 2017 UW Department of Family Medicine and Community Health (DFMCH) James E. Davis, MD, MS, Quality Improvement Award.

Above, members of the Davis Award-winning Belleville Family Medicine team receive their award at the Renner-Hansen ceremony. From left: Vicky Fahey; James Davis, MD, MS; Lisa Goecks; Peggy Soehnlein; Joan O’Connor; David Deci, MD; Jennifer Lochner, MD; Dr. Kamnetz; Dr. Gilchrist.

Better Opioid Monitoring and Prescribing Practices

One way medical staff can address the opioid crisis is through compliance with opioid monitoring and prescribing protocols. This is especially important in primary care settings for patients who have opioid-managed chronic pain.

At Belleville Family Medicine, all clinic staff were part of an improvement team to better understand the causes and challenges related to opioid management.

They focused on three aims; specifically, to increase the percentage of patients with:

  • Up-to-date medication agreements;
  • Up-to-date PHQ-9s (a tool used to screen for depression); and
  • Up-to-date urine drug screens.

To accomplish these goals, the team first created an internal registry of patients who receive opioids for chronic pain. Clinic nurses then monitored and updated the registry, and reviewed daily schedules to identify patients who needed updated medication agreements, PHQ-9s and urine drug screens—ensuring that medical assistants had the necessary forms when patients came for their appointments.

Nurses and medical assistants were also empowered to order urine drug screens on behalf of physicians and to communicate prescribing policies with patients.

The results? Between February 2016, when the project started, and November 2017:

  • Up-to-date medication agreements increased from 12.4% to 80%;
  • Up-to-date PHQ-9s increased from 40.4% to 80%; and
  • Up-to-date urine drug screens increased from 15.5% to 76.5%.

“Accidental deaths due to opioid overdose have risen in our country, our state and our local community,” notes Jennifer Lochner, MD, medical director at UW Health Belleville Family Medicine.

“It is imperative that we, as prescribers of opioids, adhere to the safest possible protocols and policies in order to avoid contributing to this public health crisis,” she continues. “Our clinic staff really came together as a team to optimize our workflows and deliver better care to these high-risk patients.”

In the future, the team hopes to build on their success by improving electronic health record charting methods for patients with chronic pain; reducing opioid and benzodiazepine co-prescribing; and identifying other options for pain management, such as behavioral and psychological support or pain group visits.

Published: November 2017