Opioid Safety at The Pharmacy Monthly Call: Opioid Risk Screening Tools

1. Opioid Safety at The PharmacyMonthly Call: Opioid Risk Screening Tools Michael Crooks, PharmD. Medication Safety Lead michael.crooks@alliantquality.org Updated Mar 2019 3/11/2019 1

2. Quality Improvement Project Flow Better Process, Better Results Define population of focus Develop Aim Statement Plan Do Study Act P P P A D A D A D S S S Determine measures of change Obtain baseline measures Re-measure Re-measure Let’s Study It RCA Root Cause Analysis

3. Indications of Success Significant increase in dispensing rate among teams reporting progress • Baseline (average) = 0.3 unit/pharmacy per month • Re-Meas. (Avg) 10/18 – 2/19 = 1.5 nits/pharmacy per month

4. Indications of Success Increase in total naloxone dispensed by 6 Pharmacy Teams • 46 Naloxone units dispensed since May 2018 • 41 Additional Naloxone units during re-measurement period (Oct– Feb) • ** One team has dispensed >20 so far in March! **

5. The Naloxone Toolkit: Displaying Performance Data You’re on track if your team has competed the following: • Measured the impact or progress made in your project • Outcomes: Naloxone dispensed; opioid counseling • Process: Identifying PoF by screening; documented counseling, follow-up, etc • Displayed the data in some format to your team

6. PDSA Updates and 1on1 Calls P D A S • Do your measures reflect success? • What have you learned from measuring your effort? • What do you need to be successful in the next month?

7. PDSA Updates and 1on1 Calls P D A S Policies & Procedures and Project Quick Reference Guide • Document the purpose of the project • Clarify the intended outcome and steps to follow • Policy/Procedures are more formal – a Quick Reference can achieve the same if P&Ps are not the norm Available at www.alliantquality.org/content/opioid-safety

8. PDSA Updates and 1on1 Calls P D A S Tracking Form • Excel Template to track • Patient name/ID • Completed counseling • Naloxone recommendation • Naloxone accepted • Follow-up w/MD • Other actions? • Or, simple printed version

9. PDSA Updates and 1on1 Calls P D A S Communicating with Prescribers • Letter writing Guide and Tips for communicating with prescribers • Sample letter to MD • Promoting opioid safety efforts at the pharmacy • Patient-specific request for naloxone

10. PDSA Updates and 1on1 Calls P D A S Communicating with Patients, Family and Caregivers • How do you support and reinforce your conversations with patients about opioid risk? • What resources do you use to educate patients about naloxone or train them to administer?

11. This Month: Risk Screening Tools

12. Opioid Risk: Opioid Risk Tool (ORT) • Typically used for chronic pain patients in primary care setting • Self-administered/ reported; fast (~1min) • Scoring: Low Risk: ≤ 3 pts Mod. Risk: 4 – 7 pts High Risk: ≥ 8 pts Source: Webster LR, et al. (Pain Med 2005)

13. Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD) • Developed in a study of patients at Veteran's Health Administration Source: Zedler B, Xie L, Wang L et al. Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans’ Health Administration Patients. Pain Medicine. Jun 2015. 16;1566-1579.

14. Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD) • Multifactorial assessment includes opioid exposure, history of dependence, chronic conditions, mental health, current health Source: Zedler B, Xie L, Wang L et al. Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans’ Health Administration Patients. Pain Medicine. Jun 2015. 16;1566-1579.

15. Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD) • Risk score is directly correlated to likelihood of opioid-induced respiratory depression occurring Source: Zedler B, Xie L, Wang L et al. Development of a Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose in Veterans’ Health Administration Patients. Pain Medicine. Jun 2015. 16;1566-1579.

16. Next Up: • Mar - Apr: Continue tests of Change. Look for new opportunities or needs to expand opioid risk counseling and naloxone focus • Apr: Telling your story: Making the case for naloxone, raising awareness and celebrating success Monthly Calls: April 17 8:30 a.m.; April 18 2:00 p.m.

17. Module 8: Re-cap • Learning Session and Team Assignment #10 – Gather with your team to review possible uses of Opioid Risk Screening tools (No slides/recording) • How can you use screening tools to guide your counseling conversation? • What other populations could benefit from opioid risk counseling and naloxone? • Survey – to be sent by email and fax • Next Calls – Register for calls next month. Links are included in follow-up emails and the annual calendar Monthly Call Slides, Learning Sessions, Team Assignments and Performance Surveys are here: http://www.alliantquality.org/content/opioid-safety

18. This material was prepared by Alliant Health Solutions, for Alliant Quality, the Medicare Quality Innovation Network – Quality Improvement Organization for Georgia and North Carolina, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. 11SOW-AHSQIN-SIP3-18-22