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Staff Buy-in, Input Needed to Curb Opioid Prescribing at Outpatient Clinics
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FORT WORTH, Texas — Large-scale changes aimed at reducing the number of opioid prescriptions at an outpatient clinic require buy-in and input from everyone on the facility’s staff, according to a poster presenter at the Rheumatology Nurses Society Annual Conference.
“We were identified as a top-10 prescriber of opioids within the Duke University system, which earned us a seat on the opioid safety task force,” Lisa Carnago, MSN, FNP, of Duke University Health Systems, told Healio Rheumatology. “We knew about some changes that were coming to the legislature in North Carolina about 6 months before they happened. We would need to check the registry to see when patients were getting opioid prescriptions, check on urine drug screens twice per year and get annual pain contracts, and I knew we weren’t doing this as well as we needed to be doing it.”
The university formed the Duke Rheumatology Opioid Task Force in May 2017 with the purpose of creating a forum to develop recommendations to increase provider and staff buy-in, as well as improve education. As part of that task force, Carnago and her team at the university rheumatology outpatient clinic — which included a nurse practitioner, a pharmacist, a nurse and a medical assistant — aimed to improve workflow and begin implementing North Carolina opioid prescribing recommendations prior to its approval by the state legislature.
According to Carnago, team members completed surveys detailing their own perceptions of the current workflow, and attended educational sessions intended for providers and clinic staff. New workflow patterns that were more consistent with the North Carolina Controlled Substance Reporting System were implemented in July 2017. Staff members also began monitoring the new workflow patterns at this time. Other targets included twice-annual urine drug screenings for patients and annual print contract initiation and renewal.
Following a task force vote in December, the university system made changes to its opioid prescription policy in January 2018, the same month the state legislature’s changes went into effect. Carnago’s team members were later surveyed again in February to assess their perceptions of the new workflow.
According to Carnago, prior to the intervention, the survey data indicated that staff were being underutilized and could do more to assist the prescribing process. Following the implementation of the new workflow, 74% of providers reported they were successfully able to accomplish the biannual drug screens and other clinic targets, up from 33% prior to the changes. In addition, 78% of providers noted they were receiving assistance from clinic staff, compared with 33% before implementation.
All of this resulted in a sharp decline in the number of opioid prescriptions issued by the rheumatology clinic, Carnago said. Between February 2015 and December 2017, the number of prescribed medications at the clinic remained steady, but the proportion of opioid prescriptions fell from 10% to 5%.
“For other practices, if they need to make similar changes, they need to get the staff buy-in of new policies, make the changes that need to be made, and figure out which education pieces they need,” Carnago said. “Long story short, to make a big change like this you need to get buy-in from everybody and incorporate them into the decision-making process.” – by Jason Laday
Reference:
Carnago L. Opioid prescribing in an outpatient rheumatology clinic: Impact of North Carolina state legislation on clinic policy and workflow. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure : Carnago reports no relevant financial disclosures.