Browsing by Subject "Drug and Narcotic Control"
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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 Using the Electronic Medical Record to Ensure Compliance with Opioid Prescription Laws in Texas(2019-03-28) Bender, Christopher McLean; Reed, W. Gary; Kandil, Enas; Fish, JasonBACKGROUND: The American population currently finds itself in the midst of a prescription drug overdose epidemic. This crisis has been fueled by an overreliance on opioid medications for the treatment of chronic pain. The state of Texas medical board (TMB) enacted a law change that restricts and regulates the prescribing and dispensing of controlled substances with respect to patients experiencing chronic pain. LOCAL PROBLEM: At the onset of this project, the University of Texas Southwestern (UTSW) system had no comprehensive measures in place to ensure compliance with these rules, and the current state of compliance was unknown. METHODS: Three clinics were chosen for observation to help understand the process of opioid prescribing for chronic pain treatment and the steps necessary to comply with the new law. Multiple Plan, Do, Study, Act (PDSA) cycles were applied to the process of baseline data measurement culminating in a final estimate of 3.1% ± 0.4% of applicable patient records written by UTSW providers in compliance with the law. INTERVENTIONS: Tools in the electronic medical record system (EMR) for tracking the use of scheduled medications in the treatment of chronic pain as well as for ensuring compliance with the new law have been developed and are in the process of implementation at the clinics with the largest populations of opioid-prescribed chronic pain patients. RESULTS: A chronic opioid registry was created, containing about 200 patients. Data retrieval is in process to determine the current rate of compliance. CONCLUSION: This project has successfully created a registry of the patients at UTSW on chronic opioid therapy and built an EMR structure that will ensure that these patients are cared for in a fashion compliant with TMB laws.