Policies, patient agreements, & workflows

Revise and implement clinic policies, patient agreements, and workflows for health care team members to improve opioid prescribing and care of chronic pain patients.

Why is this important?

Clinic policies about opioid prescribing for chronic pain create a shared understanding and agreed upon standards about how patients on chronic opioid therapy are to be managed across all providers and staff. It is important the patient agreements are aligned with clinic policies, and many clinics find it helpful to view signed patient agreements as a type of informed consent that is used to communicate risks to patients. Measures to track quality improvement efforts should be informed by the content of the clinic policies and patient agreements.

Defining standards for patient agreements, urine drug tests, and 28 day refill cycles gave Acorn Clinic providers the support they needed when encountering resistance from patients.

Example activities

  • Revise policies to align with evidence-based guidelines
  • Revise patient agreement to support revised policy and educate patients about risks

Revise, align, and implement clinic policies, patient agreements, and workflows for health care team members to improve opioid prescribing and care of chronic pain patients.

4. Policy development/revision 123 456 789 101112
Comprehensive policies* regarding chronic opioid therapy that reflect evidence-based guidelines, such as the CDC Guideline for Prescribing Opioids for Chronic Pain or state-based opioid prescribing guidelines… …do not exist. …exist, but have not been recently revised and updated. …exist, have been recently updated, but are still lacking essential components. …exist, and have been recently updated to reflect recent evidence-based guidelines, and are comprehensive.
5. Policy implementation 123 456 789 101112
Policies regarding chronic opioid therapy… …have not been distributed to clinicians and staff. …have been distributed to clinicians and staff, but have not been discussed. …have been distributed, have been discussed with all clinic staff and clinicians, but are not consistently followed. …have been distributed, have been discussed with all clinic staff and clinicians, and are consistently followed.
6. Patient agreements 123 456 789 101112
Formal signed patient agreements regarding chronic opioid therapy… …do not exist. …exist, but do not align with current clinic policies and/or are not consistently used …exist, align with current clinic policies, but are not consistently used. …exist, align with current policies, and are consistently used with all patients on chronic opioid therapy.
7. Workflows 123 456 789 101112
Clinic workflows for managing patients on chronic opioid therapy… …do not exist. …exist, but do not support current clinic policies. …exist, support current clinic policies, but are not fully implemented. …exist, support current clinic policies, and are fully implemented

*Examples of areas that a comprehensive policy might address include:

  • Prescribing opioids for acute pain (CDC #6, #7)
  • Duration and dose of opioids for chronic pain (CDC #4, #5, #8)
  • Use of non-opioid and non-pharmacological therapies (CDC #1)
  • Co-prescribing of opioids and benzodiazepines (CDC #11)
  • Urine drug screening (CDC #10)
  • Monitoring of state controlled substances database (CDC #9)
  • Patient agreements (CDC #2)
  • Patient education (CDC #2, #3)
  • Tapering of opioids (CDC #5, #7)
  • Use of naloxone (CDC #8)
  • Use of buprenorphine (CDC #12)
  • Use of methadone (CDC #4, #7)

Policy, Patient Agreement, & Workflow resources

Model policy: An example policy your clinic can use during the policy revision process; developed using the CDC guidelines.

CDC Guidelines for Prescribing Opioids for Chronic Pain

AMDG 2015 Interagency Guideline on Prescribing Opioids for Pain

Model patient agreement: An example patient agreement your clinic can use during the patient agreement revision process.

VA Opioid Taper Decision Tool: The Opioid Taper Decision Tool is designed to assist Primary Care providers in determining if an opioid taper is necessary for a specific patient, in performing the taper, and in providing follow-up and support during the taper.

Chronic pain appointment workflow: An example workflow for chronic pain appointments.

Opioid refill workflowAn example workflow for processing opioid refill requests.

Opioid list manager workflowAn example workflow for tracking and monitoring patients on chronic opioid therapy.