Continuous Improvement of a Nurse-Led Chronic Opioid Monitoring Program

Purpose: The objective was to assess the current nurse-led safety monitoring program, propose process improvements, and implement necessary changes.

Description: In 2017, a nurse-led safety monitoring program was established within the rheumatology clinic at a large academic medical center to closely monitor patients prescribed chronic opioids. The monitoring program highlighted the role of the nurse as a vigilant guardian and was aligned with institutional and national recommendations for monitoring of patients receiving chronic opioid prescriptions.

The development of the safety monitoring program improved the documentation of recommended screenings and assessments. In early 2019, documentation of the screenings and assessments decreased. Additionally, gaps in the current monitoring program were identified.

A workgroup was formed, comprised of two RNs, an LPN and a clinical nurse specialist. A baseline assessment was completed of the current safety monitoring program to identify areas for improvement. The identified areas for improvement were prioritized and a specific measurable goal for each identified need was determined. Benchmarking assisted with formulating proposals for process improvement.

The workgroup collaborated with multidisciplinary members within the division to garner support for workflows that extended beyond nursing. After approval of process improvements, a comprehensive education session was conducted with the nursing team to review the safety monitoring program. The monitoring program was also reviewed at a division meeting to ensure all team members were aware of and on board with changes.

Evaluation/outcome: Improvements to the established safety monitoring program included identification and implementation of a multidisciplinary escalation process to use when safety concerns arise. Additionally, a standard multidisciplinary process was established for patients requiring a urine screen prior to prescription pick-up.

Metrics showed improved results for documentation of all recommended education, screenings, and assessments. The annual RN education visit and the controlled substance agreement were completed for an additional 34% and 17%, respectively, of the total patients on chronic opioids. Annual urine drug screen completion rates increased an additional 50%. The state prescription monitoring program was reviewed 55% more frequently. A multidisciplinary opioid plan of care was established for an additional 35% of the total patients on chronic opioids.

A comprehensive, nurse-led safety monitoring program for patients prescribed chronic opioids assists with adherence to institutional and national safety recommendations. Continuous improvement of such a program supports continued success.

References
1. Costello, M. (2015). Prescription opioid analgesics: Promoting patient safety with better patient education. American Journal of Nursing, 115(11), 50-56.
2. Dowell, D., Haegerich, R., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016. Retrieved from https://www.cdc.gov/mmwr/
3. volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2F
4. www.cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm