A physician with a large population of patients who were prescribed opioid analgesics was on the receiving end of a medical board complaint. The complaint was brought to our consultants’ attentions. They promptly performed an evaluation and observed the following problems:
- The initial work-up of patients receiving opioid analgesics did not consistently include a comprehensive physical examination, screening for substance use disorder and depression
- Re-evaluation and functional assessments were not performed on a regular basis
- A treatment plan was not established
- Informed consent and treatment agreement was not obtained
- Opioid trials were not employed
- Medical records did not support that there were attempts to reduce/taper the regimen
- The physician was not using a prescription monitoring data base
Afterwards, several one-on-one meetings were held with the physician and staff to review the findings and to assist with implementing processes related to patients receiving opioid analgesics. Recommendations for how to implement the medical board’s policies on treating patients with chronic pain into the practice were addressed. The physician was also given information on registering to use the prescription-monitoring database for that state.
In addition to following all the provided guidance the physician obtained additional education on managing patients with chronic pain issues, and began referring more complex patients to pain clinics. The changes made a positive impact on patient safety in the office and significantly reduced the physician’s medical liability exposure. The corrective actions also resulted in the board’s dismissal of the complaint against the physician.
Find out more about the CDC's new guidelines on prescribing opioids.
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