Resources for Clinics

COVID-19 handout: A resource to help primary clinics think through how to continue to care for their patients with chronic pain on long-term opioid therapy while maintaining good public health practices during the COVID-19 event.

The following resources can help clinics implement each of the Six Building Blocks to improving opioid management.

Leadership & Consensus resources

Opioid harm stories: Stories are the emotional drivers for engaging clinicians. Here are some personal stories of the harm caused by opioids.

Building an opioid improvement team: Information about who should be on an opioid improvement team to lead opioid management quality improvements.

Six Building Blocks self-assessment: A tool that can be used to measure status in the Six Building Blocks, both as a small group activity during site visits and by the Opioid Improvement Team to track progress over time.

Clinical education opportunities: This resource lists clinical education opportunities on opioids and chronic pain by topic.

CDC training and webinars: The CDC has an interactive clinical training series and a webinar series available to the public.

UW TelePain: A clinical education resource.

CME Pain Management Course: We highly recommend all clinicians and staff receive training on pain etiology. This course from the Oregon Pain Management Commission is an excellent resource.

Elevator Speech on Six Building Blocks: This resource helps you think through how to talk with others in your organization about why you are improving opioid management through the Six Building Blocks.

Motivating slow to adopt providers: Specific strategies for encouraging providers to adopt the practices in the revised policies.

Levers of motivation guide: Ways to motivate providers and staff.

Chronic Pain Management Teams: This resource supports the development of a Chronic Pain Management Team.

Policy, Patient Agreement, & Workflow resources

Model policy: An example policy your clinic can use during the policy revision process; developed using the CDC guidelines and Washington state opioid prescribing rules.

Policy checklist: A checklist to use when reviewing if your policy aligns with evidence-based guidelines.

CDC Guidelines for Prescribing Opioids for Chronic Pain

AMDG 2015 Interagency Guideline on Prescribing Opioids for Pain

Model patient agreement: An example patient agreement your clinic can use during the patient agreement revision process.

Chronic pain appointment workflow: An example workflow for chronic pain appointments.

Remote urine drug testing FAQ and workflow: A resource to think through how to conduct urine drug testing remotely.

Opioid refill workflow: An example workflow for processing opioid refill requests.

Opioid list manager workflow: An example workflow for tracking and monitoring patients on long-term opioid therapy.

Rollout and training: A resource to think through how to do rollout and training on new approaches.

Tracking & Monitoring Patient Care resources

Morphine Equivalent Dose (MED) calculator

Approaches to identifying patients: Suggested approaches to try when first attempting to identify your patients on long-term opioid therapy.

Developing a tracking and monitoring dashboard: Tips for developing a tracking and monitoring dashboard.

Purposes of tracking & monitoring: An outline of the key uses of data in tracking & monitoring patients on long-term opioid therapy to use when planning your approach.

Data to consider tracking: A list of variables to consider tracking and monitoring for care planning and measuring success.

WSMA opioid management dot phrases: Washington State Medical Association resource to help develop EHR templates and workflows for opioid management.

Tracking & Monitoring example spreadsheet: An Excel spreadsheet a clinic can adapt to track and monitor key measures overall and by provider if they are unable to easily pull reports from their EMR.

List of opioid names: A list of opioids to use in identifying patients on long-term opioid therapy.

List of sedative names: A list of sedatives to use in identifying patients on concurrent sedatives and opioids.

Planned, Patient-Centered Visits resources

Patient education

Education resources for patients with chronic pain: A list of patient education materials relevant to patients with chronic pain, including resources about opioids, benzodiazepines, chronic pain, overdose, stigma, and pain self-management. 

CDC patient education example: A handout for patients educating them on the risks of long-term use of opioids.

Patient letter: A letter introducing patients to the clinic’s new approach to caring for patients on long-term opioid therapy.

WA DOH chronic pain patient notification: A handout for patients educating them on the risks of long-term use of opioids, disposal, and safe storage.

WA DOH acute pain patient notification: A handout for patients educating them on the risks of acute use of opioids, disposal, and safe storage.

Chronic pain care plan example: A chronic pain care plan is a tailored set of written steps and key information that a provider and patient agree will be used to manage the patient’s pain.

Tapering

BRAVO Protocol: The BRAVO protocol outlines a safe and compassionate strategy to approach opioid tapering, while also maintaining a therapeutic alliance.

VA Opioid Taper Decision Tool: The Opioid Taper Decision Tool is designed to assist Primary Care providers in determining if an opioid taper is necessary for a specific patient, in performing the taper, and in providing follow-up and support during the taper.

HHS Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics: The Guide covers important issues to consider when changing a patient’s chronic pain therapy.

Difficult conversations

Provider guide to difficult conversations: Key principles and specific scripts to help providers navigate difficult conversations.

Staff guide to difficult conversations: Suggested conversation approaches and scripts for clinical and administrative staff who interact with patients on long-term opioid therapy.

Difficult Conversations video vignette: An example that illustrates using principles of how to have a difficult tapering conversation with a patient.

Empathic communication resources: A list of empathic communication and motivational interviewing resources.

Non-opioid treatments

Alternative treatments fact sheet: CDC recommended non-opioid treatments for chronic pain.

Evidence on complementary and alternative approaches to chronic pain: A summary of existing evidence for noninvasive non-pharmacological treatments and complementary health approaches for chronic pain conditions.

Chronic pain self-management resources: A list of suggested resources for providers, care coordinators, and patients to use for chronic pain self-management.

Health effects of cannabis and cannabinoids: Chapter highlights from the 2017 Report from The National Academies of Sciences, Engineering, and Medicine.

Planning for visits

Tips for managing patients on legacy prescriptions: Suggestions for how to approach patients you have inherited from another clinician.

Risk stratification and opioid prescribing: Suggestions for how to screen for and vary care according to risk level.

Turn the Tide pocket guide for clinicians: A quick reference for clinicians about opioid prescribing.

Pain Tracker: An example guide of assessments to use during visits about chronic pain.

Suggested opioid management schedule: A table outlining suggested tools and timelines for opioid management assessments.

Stigma and chronic pain: A resource describing the relationship between chronic pain and stigma. It includes approaches to address stigma in the primary care setting.

Social determinants of health and pain management: A document outlining the connection between social determinants of health and pain management, including resources to help plan patient visits.

For specific assessment tools, such as the Opioid Risk Tool, see Recommended Assessment table.

The CDC offers many helpful clinical tools on their website.

Caring for Patients with Complex Needs resources

Assessment and treatment

Opioid Use Disorder (OUD) diagnosis form: A form outlining the criteria to diagnose OUD using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.

Developing a Buprenorphine Treatment Program for Opioid Use Disorder in Primary Care: A resource that guides primary care organizations and providers in developing a buprenorphine treatment program for opioid use disorder (OUD).

SAMHSA Medication-Assisted Treatment webpage: This webpage includes information, such as how to find MOUD/MAT and how to get waivered to prescribe buprenorphine.

PCSS Online MOUD Waiver Training: This 8-hour training will assist physicians and physician assistants (PAs) who wish to apply for a waiver to prescribe buprenorphine for the treatment of opioid use disorders. 

Online webinars on assessing and treating OUD:

Identification, Counseling, and Treatment of OUD: An 8-hour training from Harvard Medical School that focused on current best practices in identification and treatment of OUD.

Collaborative Care Approaches for Management of OUD: An 8-hour training from Harvard Medical School that focuses on collaborative care strategies which include: provider roles and regulatory requirements; patient evaluation and patient education; transitioning between medications; potential misuse, relapse, and safer use; and caring for pregnant women and other special populations with OUD.

SUD 101 Core Curriculum: This training series from PCSS offers 22 modules that provide an overview of evidence-based practices in the prevention, identification, and treatment of substance use disorders and co-occurring mental disorders.

Case consultation resources:

Preventing overdose

Naloxone information from SAMHSA: Naloxone is a medication to counter opioid overdose.

Preventing an opioid overdose tip card: A tip card by the CDC on how to prevent an opioid overdose and what to do in the event of an overdose.

Opioid overdose response handout: A printable handout from the Center for Opioid Safety Education on what to do in the case of an overdose.

WA naloxone standing order resource: The purpose of this standing order is to facilitate wide distribution of the opioid antagonist naloxone so people in Washington can provide assistance to persons experiencing an opioid-related overdose.

Stigma

Reducing Stigma:  A resource addressing stigma and harm reduction for patients with opioid use disorder from Alberta Health Services, which includes language suggestions.

Guiding Principles for Addressing the Stigma on Opioid Addiction: A resource from Johns Hopkins offering evidence-based guiding principles that should inform all activities intended to reduce the stigma surrounding opioid use disorder.

Changing Language to Change Care: A PCSS Learning Module on Substance Use Disorder.

Measuring Success resources

Measuring success metrics: A list of potential aims to use to measure success

CDC Quality Improvement Measures: Measures that align with the recommendations outlined in the CDC Guideline for Prescribing Opioids for Chronic Pain.

Measuring outcomes survey: A survey to assess measures at the start and end of practice transformation work.

Prepare and Launch milestones: A tool to track progress in achieving Prepare and Launch stage milestones.

Design and Implement milestones: A tool to track progress in achieving milestones of improving opioid management through the Six Building Blocks Program.

DIY Run Chart: A DIY Excel tool from the Safety Medical Home Initiative that you can use to track progress over time on a measure (e.g., up-to-date patient agreements).

Event tally: A form to help a clinic track a simple measure of interest over a couple weeks.

Self-Service How To Guide

Through funding from the Agency for Healthcare Research and Quality, the Six Building Blocks team and Abt Associates created a guide for clinics who want to independently implement effective, guideline-driven care for their patients with chronic pain who are using opioid therapy. While anyone can use these materials to implement improvements in opioid management, it is specifically written for quality improvement personnel and project managers to use in guiding an improvement team and care teams through the Six Building Blocks implementation process.

Introduction

Stage 1: Prepare and Launch

Stage 2: Design and Implement

Stage 3: Monitor and Sustain