Opioid Management Toolkit
This toolkit provides information on effectively managing opioid usage in the hospital or clinic setting. The reference documents provided below address topics such as opioid prescribing practices, risk assessments, patient monitoring and opioid overdose.Pain Management Safety
This section of the toolkit consists of many tools related to pain management safety covering standards, patient agreement forms, screenings, practices, safety interventions and oversedation risks related to post administration of opioid therapy.
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The AAMI Foundation 2015 Opioid Compendium
The AAMI Foundation, with the support of key industry partners and other patient safety organizations, has launched a multiyear initiative to highlight the potentially catastrophic patient safety problem of opioid over sedation and misuse, making the case for a solution that can save lives: continuous electronic monitoring (CEM).
In this report, you will read about four families who suffered the death of a loved one due to undetected respiratory depression caused by opioid use, as well as the harrowing experience of a patient who narrowly missed becoming yet another statistic.
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TJC Enhances Pain Assessment and Management Requirements
From the Joint Commission Perspectives Newsletter comes the announcement of new and revised pain assessment and management standards that will go into effect January 1, 2018. Developed through rigorous research, evaluation and review processes, these enhancements will facilitate safer opioid prescribing and management practices for healthcare providers.
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Organization Assessment for Safe Opioid Practices
The proactive assessment of safety practices, especially those involving opioid use, can provide hospitals with valuable information about the weaknesses that exist within their medication-use system. Because the harm from errors involving opioids is potentially devastating, identifying the risks associated with opioid use should be considered a priority by healthcare organizations.
This assessment tool will help you analyze the safety of opioid practices in your facility and identify those key opportunities for improvement.
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Patient Agreement Forms for Pain Treatment
In this resource, you will find two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or other controlled substances. These documents contain statements to help ensure patients understand their role and responsibilities regarding their treatment, the conditions under which their treatment may be terminated, and the responsibilities of the healthcare provider. These documents can help facilitate communication between patients and healthcare providers and resolve any questions or concerns before initiation of long-term treatment with a controlled substance.
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San Diego Patient Controlled Analgesia Guidelines Toolkit
These guidelines were developed by the San Diego Patient Safety Task Force to provide acute care clinical leaders with recommendations for the standardization of intravenous Patient Controlled Analgesia (PCA) medication administration in the care of the opioid naïve patient.
The PCA is an interactive method of pain management that allows patients to manage their pain by self-administering doses of analgesics, which usually involves opioids.
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Safeguarding Patients with Surveillance Monitoring
Dartmouth-Hitchcock Medical Center describes their journey from FMEA through performance improvement in reduction of adverse events related to over-sedation from opioid administration. This article offers best practices, challenges faced, solutions identified and the outcomes achieved through an interdisciplinary project which led to positive patient outcomes.
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Continuous Monitoring of Patient Vital Signs to Reduce Failure-to-Rescue Events
Johns-Hopkins Hospital describes their organization's successful continuous patient monitoring project. The organization’s philosophy was that no patient should suffer a failure-to-rescue event and they set out to implement processes to achieve that goal. This article describes how they used technology to improve patient outcomes and failure-to-rescue events related to over-sedation.
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Richmond Agitation Sedation Scale (RASS)
An evidence-based, objective sedation scale that can be used to determine a patient’s level of sedation. The scale helps you rank patients from combative through non-arousable states.
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Pediatric Acute Pain Management (Children’s Minnesota)
Sample policy and dosing guidelines for pain management in the pediatric population developed by Children’s Minnesota using the WHO Guidelines as a reference. This sample addresses the use of opioids, non-opioid medications and alternative therapy treatment based on the level of pain in a pediatric patient.
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Center for Medicare & Medicaid Services: Maternal Opioid Misuse (MOM) Model
The Maternal Opioid Misuse Model provides strategies to combat the opioid crises in the maternal health population.
Opioid Management Resources
The overdose of opioids can be fatal. The following attachments are provided to assess and treat patients at risk and prevent and reduce overdoses.
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CMS Clinical Standards Survey and Certification Letter
The Institute of Medicine has defined an ADE as an “injury resulting from medical intervention related to a drug.” It’s estimated that one-third of all adverse hospital events are related to ADEs, resulting in almost two million hospital visits annually. Each year, serious adverse events, including fatalities, occur due specifically to the misuse of intravenously administered opioids in hospitals.
This letter from the Centers for Medicaid and Medicare Services (CMS) outlines the requirements for hospital medication administration, particularly IV medications and post-operative care of patients receiving intravenous opioids.
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Worksheet for Discussing Opioid Management with Medical Professionals
This worksheet is a component of the Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. It offers key points to consider and address when engaging with medical professionals and discussing an opioid management program for their hospital or clinic.
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Opioid Addiction Risk Assessment Tool
Healthcare facilities can use this assessment for practitioners who prescribe, dispense, and/or administer opioid products. The assessment tool addresses selection, dosing and patient monitoring when using opioid products. This tool was developed by the Pennsylvania Patient Safety Authority in collaboration with the Pennsylvania Medical Society.
Aggregating and analyzing the results of practitioner assessments can help healthcare facilities identify opportunities for improvement and aid in the development of targeted, high-leverage strategies to improve the safe use of opioids.
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Pasero Opioid Induced Sedation Scale (POSS) Presentation
This is a PowerPoint presentation on the practical use of the Pasero Opioid-Induced Sedation Scale (POSS) as well as when and how to utilize it within the hospital. Healthcare professionals may use this presentation to educate their staff on how to monitor a patient’s response to opioid administration by monitoring their level of sedation. This presentation will help staff understand how to evaluate a patient’s response to opioid pain therapy and when it is safe to administer additional medication to patients.
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Opioid Risk Assessment Tool
A patient risk assessment to help determine the level of risk a patient may have for being over-sedated with the use of opioid pain management.
Opioid Overdose Response and Prevention Tools
Due to the rise of opioid overdoses, it is vital to implement a plan to manage these circumstances. Strategies to prepare staff response, prevent overdose and attend to an overdose patient can be viewed below.
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CDC Opioid Overdose Prevention Toolkit
Compiled by the CDC, this toolkit is meant to provide information to healthcare providers, community members, patents and family who deal with the use of opioid prescriptions. It includes facts for the community, essential steps for first responders, information for prescribers, safety recommendations for patients and their family members and information about recovering from and preventing opioid overdose .
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Worksheet for Developing an Overdose Response Plan
This worksheet is a component of the Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. This resource provides key elements to consider when developing an overdose response plan for your facility. These considerations include prior opioid overdose events, heightened risk locations within the building, offsite encounters and staff emergency response training.
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How to Assemble a Naloxone Kit and Prepare Educational Materials
This worksheet is a component of the Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. This resource provides guidelines for assembling a proper naloxone take home kit and describes the appropriate educational and instructional materials to include for the recipient.
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How to Implement Low Cost Opioid Overdose Prevention Strategies Worksheet
This worksheet is a component of the Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. It includes important ways your team can integrate overdose prevention into your current work routine at little to no cost to your program.
Although all of these suggestions may not be relevant to your unique program structure, they are a great starting point to begin brainstorming ways that overdose prevention can fit into your facility’s program.
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Opioid Overdose Prevention Tips Worksheet
This worksheet is a component of the Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects, produced by Harm Reduction Coalition. In this resource, you will find helpful overdose prevention tips and insights into the common risks for opioid overdose events. Remember: Not every prevention method is applicable or pragmatic for every situation. The advice in this worksheet is meant to be used as a guideline to customize prevention methods specific to your needs.
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Article: Continuous Monitoring of Patient Vital Signs to Reduce Failure-to-Rescue Events
Johns-Hopkins Hospital describes their organization's successful continuous patient monitoring project. The organization’s philosophy was that no patient should suffer a failure-to-rescue event and they set out to implement processes to achieve that goal. This article describes how they used technology to improve patient outcomes and failure-to-rescue events related to over-sedation.
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CDC: Opioid Overdose
The CDC provides resources on opioid overdose facts and prevention strategies along with resources to raise awareness.
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CMS Opioid Misuse Strategy 2016
Resources are provided to assist healthcare practitioners, families and patients understand the potential misuses of opioids and techniques to limit misuse.
Opioid Prescribing Best Practices
Recommendations, tools, sample policies and protocols can be found in Opioid Prescribing Best Practices. This data distributes information on chronic pain, pain experienced by specific age populations and particular requirements involved with these medication's dispensing.
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CDC Opioid Prescribing Recommendations
These are the recommended practices from the CDC for prescribing opioids for the treatment of chronic pain in the clinical setting. These recommendations are not intended for the use of opioids in treating active cancer, palliative care or end-o- life care.
By following these recommendations, you and your healthcare team may reduce risks associated with long-term opioid therapy.
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Opioid Knowledge Assessment Tool
Healthcare facilities can use this assessment for practitioners who prescribe, dispense and/or administer opioid products. The assessment tool addresses selection, dosing and patient monitoring when using opioid products. This tool was developed by the Pennsylvania Patient Safety Authority in collaboration with the Pennsylvania Medical Society.
Aggregating and analyzing the results of practitioner assessments can help healthcare facilities identify opportunities for improvement and aid in the development of targeted, high-leverage strategies to improve the safe use of opioids.
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Sample Policy for Prescribing Controlled Substances
This is a sample policy that provides guidelines for the appropriate actions needed when a patient, suspected of abusing drugs, requests a prescription for a controlled substance from an emergency practitioner. This resource aims to provide practitioners with an outlined method for handling prescribing concerns related to individuals who chronically use opioids.
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CDC Guidelines for Prescribing Opioids for Chronic Pain
These clinical practice guidelines have been developed to provide recommendations for prescribing opioid pain medications in the primary care setting while establishing safer, more effective treatment of chronic pain.
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WHO Guidelines on the Pharmacological Treatment of Persisting Pain in Children
Pain in the pediatric population can be challenging, but it cannot be ignored. These evidence-based guidelines can help organizations design policies and procedures to improve the management of pain in children. The guidelines provide an overview of pain classifications, evaluation of pain in children and recommended treatments according to the level of pain. In addition, background information is provided to support clinical recommendations.
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Safe Prescribing of Opioids in Pediatric and Adolescent Populations
A sample policy, developed by the state of Pennsylvania, addresses the appropriate management of pain in pediatric patients. The policy uses evidence-based practice guidelines to address the use of opioids and the prevention of opioid use disorder while providing an overview of pain in children.
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How to Make an Inquiry Using PMP Aware
The Prescription Monitoring Program (PMP) requires dispensers (pharmacies as well as other practitioners dispensing to their patients) of controlled substances and other drugs of concern to report the essential data elements of those transactions to the program. The program houses this data in a secure database and makes that information available to authorized users — primarily prescribers and dispensers caring for their own patients.
This downloadable document will walk you through the process of making an inquiry within the PMP Aware database.
Educational Resources
Education is crucial to the prevention of an overdose. The following presentation shares concerns related to the risks, patient monitoring and development of policies. This material prepares staff to maintain safety with the administration of opioids.
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Opioid Staff Education Presentation
Pain management with opioids has been associated with errors that have resulted in over-sedation, respiratory depression and death. Nurses are in a key position to assess, monitor, educate and advocate for patients in all clinical settings. Therefore, nurses should be educated about the concerns related to these high-risk medications and the key role they play in keeping patients safe.
This presentation is designed to help organizations educate their nursing staff regarding the dangers of opioid therapy and how they can impact patient care in their current role. The presentation would be best supplemented with the addition of your own organizational policies surrounding the management of opioids. Feel free to download this presentation for use on your internal LMS.