Cargando…
Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3
OBJECTIVE: Use an established quality improvement method, Lean A3, to improve the process of opioid prescribing in an academic rheumatology ambulatory clinic. METHODS: This retrospective pre‐postintervention analysis of rheumatology records included patients prescribed opioids at least once during t...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857975/ https://www.ncbi.nlm.nih.gov/pubmed/31777838 http://dx.doi.org/10.1002/acr2.11078 |
_version_ | 1783470859583750144 |
---|---|
author | van Eeghen, Constance Edwards, Melinda Libman, Bonita S. MacLean, Charles D. Kennedy, Amanda G. |
author_facet | van Eeghen, Constance Edwards, Melinda Libman, Bonita S. MacLean, Charles D. Kennedy, Amanda G. |
author_sort | van Eeghen, Constance |
collection | PubMed |
description | OBJECTIVE: Use an established quality improvement method, Lean A3, to improve the process of opioid prescribing in an academic rheumatology ambulatory clinic. METHODS: This retrospective pre‐postintervention analysis of rheumatology records included patients prescribed opioids at least once during the study period. Lean A3 was used to develop a Controlled Substance Visit Protocol to standardize eight recommended elements of the opioid prescribing workflow. Analyses included changes in the recommended workflow elements and changes in opioid prescribing volume. RESULTS: Improvements were observed in seven of the eight recommended elements. Patient education, including treatment agreements and consent forms (39% completion for both preimplementation) increased to 78% and 80%, respectively (P < 0.001 for both). Risk assessment, as measured by the Current Opioid Misuse Measure, increased from 0.5% to 76% (P < 0.001). Best practices in prescribing, including prescribing in multiples of seven to avoid weekend refill requests, increased from 1% to 79% (P < 0.001). Monitoring parameters, including standardized functional assessment (0% vs. 86%), prescription drug monitoring program queries (49% vs. 84%), and urine testing (1% vs. 32%) all increased (P < 0.001). Visits scheduled at least quarterly for patients on chronic opioids did not change (P = 0.18). Overall, the number of patients prescribed opioids (185 vs. 160; P < 0.001) and annual prescription opioid morphine milligram equivalents (MMEs) (1 933 585 MME vs. 1 386 368 MME; P < 0.001) decreased. CONCLUSION: The Lean A3 method is a successful quality improvement tool for improving and sustaining opioid prescribing within a single academic rheumatology clinic. This method has potential applicability to similar clinics interested in improving opioid prescribing. |
format | Online Article Text |
id | pubmed-6857975 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-68579752019-11-27 Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 van Eeghen, Constance Edwards, Melinda Libman, Bonita S. MacLean, Charles D. Kennedy, Amanda G. ACR Open Rheumatol Brief Reports OBJECTIVE: Use an established quality improvement method, Lean A3, to improve the process of opioid prescribing in an academic rheumatology ambulatory clinic. METHODS: This retrospective pre‐postintervention analysis of rheumatology records included patients prescribed opioids at least once during the study period. Lean A3 was used to develop a Controlled Substance Visit Protocol to standardize eight recommended elements of the opioid prescribing workflow. Analyses included changes in the recommended workflow elements and changes in opioid prescribing volume. RESULTS: Improvements were observed in seven of the eight recommended elements. Patient education, including treatment agreements and consent forms (39% completion for both preimplementation) increased to 78% and 80%, respectively (P < 0.001 for both). Risk assessment, as measured by the Current Opioid Misuse Measure, increased from 0.5% to 76% (P < 0.001). Best practices in prescribing, including prescribing in multiples of seven to avoid weekend refill requests, increased from 1% to 79% (P < 0.001). Monitoring parameters, including standardized functional assessment (0% vs. 86%), prescription drug monitoring program queries (49% vs. 84%), and urine testing (1% vs. 32%) all increased (P < 0.001). Visits scheduled at least quarterly for patients on chronic opioids did not change (P = 0.18). Overall, the number of patients prescribed opioids (185 vs. 160; P < 0.001) and annual prescription opioid morphine milligram equivalents (MMEs) (1 933 585 MME vs. 1 386 368 MME; P < 0.001) decreased. CONCLUSION: The Lean A3 method is a successful quality improvement tool for improving and sustaining opioid prescribing within a single academic rheumatology clinic. This method has potential applicability to similar clinics interested in improving opioid prescribing. John Wiley and Sons Inc. 2019-09-04 /pmc/articles/PMC6857975/ /pubmed/31777838 http://dx.doi.org/10.1002/acr2.11078 Text en © 2019 The Authors. ACR Open Rheumatology published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Brief Reports van Eeghen, Constance Edwards, Melinda Libman, Bonita S. MacLean, Charles D. Kennedy, Amanda G. Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title | Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title_full | Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title_fullStr | Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title_full_unstemmed | Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title_short | Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3 |
title_sort | order from chaos: an initiative to improve opioid prescribing in rheumatology using lean a3 |
topic | Brief Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857975/ https://www.ncbi.nlm.nih.gov/pubmed/31777838 http://dx.doi.org/10.1002/acr2.11078 |
work_keys_str_mv | AT vaneeghenconstance orderfromchaosaninitiativetoimproveopioidprescribinginrheumatologyusingleana3 AT edwardsmelinda orderfromchaosaninitiativetoimproveopioidprescribinginrheumatologyusingleana3 AT libmanbonitas orderfromchaosaninitiativetoimproveopioidprescribinginrheumatologyusingleana3 AT macleancharlesd orderfromchaosaninitiativetoimproveopioidprescribinginrheumatologyusingleana3 AT kennedyamandag orderfromchaosaninitiativetoimproveopioidprescribinginrheumatologyusingleana3 |