Browsing by Subject "Drug Prescriptions"
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Item Assess Effectiveness of Opioid Prescription Policies for Acute Pain Management(2022-05-01T05:00:00.000Z) Machchhar, Arti; Reed, W. Gary; Phelps, Eleanor; Kandil, EnasBACKGROUND: In 2017, the Department of Health and Human Services (HHS) declared the Opioid Crisis a public health emergency. Regulatory agencies and institutions have adopted several guidelines to ensure opioids are prescribed appropriately. In October 2014, the DEA changed the schedule of hydrocodone combination products (HCPs) from schedule III to schedule II narcotics. This led to a substantial rise in Tylenol 3 prescriptions at the University of Texas at Southwestern Medical Center (UTSW) due to the institutional guideline that prevents residents from prescribing schedule II narcotics without documented approval from an attending physician. OBJECTIVE: We sought to evaluate whether the UTSW guideline preventing residents from prescribing schedule II narcotics serves to improve patient safety and pain management. METHODS: Prescription data and associated patient demographic data was pulled directly from the UTSW electronic medical record (EMR) for one year prior to and following the rescheduling of HCPs. Additional data was pulled for the 2019 and 2020 calendar years. The proportion of T3 and schedule II narcotic prescriptions was calculated for all time periods and stratified for age, race, provider type, and department. RESULTS: One year before the rescheduling of hydrocodone, the vast majority of prescriptions were schedule II narcotics at 98.92% and T3 was very rarely prescribed at 1.08%. In 2014 - 2015 following the rescheduling of HCPs, there was an overall decrease in opioid prescriptions and the proportion of T3 prescriptions rose to 49.94%. In 2019 and 2020, the overall number of opioid prescriptions increased to 17,297 in 2019 and 15,395 in 2020 and the proportion of T3 prescriptions decreased to 37.12% and 33.89% respectively. CONCLUSION: The rescheduling of HCPs led to the dramatic shift in Tylenol 3 prescriptions, indicating that regulatory agencies and institutional guidelines are driving prescribing habits. Tylenol 3 is being prescribed at a significant rate however, information regarding its addictive potential, metabolic effects, and potential adverse effects remains relatively unknown. The drug policies and institutional guidelines discussed disproportionately affect people of color and lower socioeconomic class.Item Improving Adherence to Opioid Prescribing CDC Guidelines for Chronic Pain(2021-05-01T05:00:00.000Z) Zamir, Aemen; Reed, W. Gary; Kandil, Enas; Phelps, EleanorBACKGROUND: The Centers for Disease Control and Prevention have released treatment guidelines for chronic pain care as concerns about opioid overuse and abuse increase. Additionally, The Texas Medical Board has outlined their policy for the use of medication for non-malignant chronic pain purposes in Rule 170.3 of the Texas Administrative Code. Some of the requirements include a signed pain management agreement, regular review of the Prescription Monitoring Program, a urine drug screen, and documentation of completion of requirements in patient's medical records. OBJECTIVE: Establish baseline adherence to TMB policy for opioid prescribing and implement electronic medical record tools to facilitate completion of requirements METHODS: A preliminary chart review of patients on the opioid registry, an intervention in early phase of implementation meant to easily identify patients receiving opioids for chronic pain, was conducted to determine baseline adherence to Rule 170.3 amongst physicians. Several CDC guidelines which corresponded with TMB requirements were chosen. Post-intervention data was collected from the chronic opioid registry regarding the percentage of patients who had annual review of Prescription Monitoring Database, a urine drug screen, a pain management agreement, and documentation of completion of requirements in patient's medical records. RESULTS: Of the 206 patients studied through chart review pre-intervention, only 6% had all three TMB mandated elements in their charts. After implementing the EMR tools meant to facilitate completion of TMB laws and CDC guidelines, the percentage of patients with a urine drug screen and review of PDMP increased while the percentage of patients with a pain management agreement in their chart decreased. CONCLUSION: Poor compliance in the UTSW system necessitates tools that will streamline the process for completing and documenting the requirements. The implementation of the EHR tools and the opioid registry best practice alerts, as they were rolled out by the Opioid Task Force, helped facilitate completion of requirements.Item Understanding Institutional Physician Chronic Opioid Prescription Practices for the Improved Implementation of Newly Developed EMR Tools(2021-03-12) Gagrani, Sonal; Reed, W. Gary; Phelps, Eleanor; Kandil, EnasBACKGROUND: Chronic non-cancer pain (CNCP) affects a significant portion of the United States population each year and is often treated with chronic opioids. There has been a rise in prescription opioids over the past 20 years, accompanied by a rise in overdose deaths as well. In order to improve patient safety related to opioid prescribing, several state and national policies including the 2016 "CDC Guidelines for Prescribing Opioids for Chronic Pain" have been developed recently to guide CNCP management. These recommendations include the use of pain management agreements, urine drug screening, prescription monitoring programs (PMP) and risk and pain assessments among others. LOCAL PROBLEM: In Texas, several recent policies have made CNCP practices mandatory, requiring support in order to enforce them. At the University of Texas Southwestern Medical Center (UTSW), there is no current reliable measure of CNCP policy adherence. Preliminary chart review by students at our institution showed low adherence overall, which may be secondary to poor documentation. METHODS: A set of surveys were developed to subjectively measure physician barriers to policy adherence, attitudes toward the policy components and current opioid prescribing practices. This survey was administered via electronic communication before and after the intervention to any physician at our academic medical center prescribing chronic opioids to at least one patient. Implementation science outcomes of appropriateness, adoption and acceptability were targeted by these surveys in order to inform implementation strategies for the intervention. INTERVENTIONS: A multi-faceted intervention including an electronic medical record (EMR) navigator tool, chronic opioids registry and physician education was developed by the institutional opioid task force to improve accessibility, documentation and understanding of opioid prescribing guideline recommendations. RESULTS: Physicians who had used the EMR navigator tool reported overall greater use of several guideline-concordant treatment components compared to those who had not used it (p < .05). Physicians who received opioid prescribing training were more aware and familiar with the policy (p < .0001). Those who were more familiar with the policy were more likely to use pain management agreements, urine drug screens and pain assessments. No specific barriers to policy adherence stood out as a remediable concern. Only a small percentage of respondents reported co-prescribing naloxone for high-risk CNCP individuals. CONCLUSION: An EMR navigator tool to improve accessibility of treatment components is effective in improving policy adherence at an academic medical center. Physician education is also effective in improving awareness and familiarity with the policy. Future steps include the study of patient-centered outcomes surrounding the intervention. There is also room for the support of other CNCP guidelines including co-prescription of naloxone for high-risk individuals and decreasing chronic opioid prescription strengths at our institution.