Title

Implementing Evidence-based Opioid Prescription Practices In a Primary Care Setting

Date of Degree

12-2017

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Jean Dowling Dols

Advisor

John Dickson

Abstract

The use and misuse of opioid pain medication has reached epidemic proportions in the United States. More than 16,000 people die each year due to the misuse or abuse of prescription opioid medications, which is more than from heroin, cocaine, and benzodiazepines combined. The purpose of this evidence-based practice project is to establish processes enabling a primary care clinic to implement and adhere to the 2016 Centers for Disease Control’s guidelines for opioid prescription practices in the primary care setting. A retrospective chart review conducted prior to implementation of the guidelines demonstrated that four of six of the CDC’s recommendations were in place. Following the Centers for Disease Control guidelines, a process was implemented to track evidence-based interventions including screening for potential abuse, urine drug screening, patient education, provider assessment of need, accessing the prescription drug monitoring program database, and the completion of a treatment agreement. Prior to implementation, a retrospective chart study revealed that none of the patients were screened for potential abuse, 80% had completed a treatment agreement, 90% had received education on opioid medication and potential abuse, 75% had undergone urine drug screening, 5% had the prescription drug monitoring program database accessed, and 95% had a documented provider assessment of need for treatment. At the completion of the project, 82% of patients were screened for potential abuse, 100% had completed a treatment agreement, 93% received education on opioid abuse, 93% underwent urine drug screening, 68% had the prescription drug monitoring program database accessed, and 96% had a documented provider assessment of need. The implementation of these guidelines has led to 11 (7%) patients being referred to a pain management specialist and a 10% reduction in the number of prescriptions written for opioid pain medications for patients seeking treatment for chronic pain.

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