Stage 2: Design & Implement – Six Building Blocks

Implementation Guide

The investigative and focusing work done during the Prepare and Launch Stage offers the Opioid Improvement Team a picture of current practices, resources, and possibilities. Now it is time to put that foundational work to good use and help practices design and implement new approaches to care for patients on long-term opioid therapy using the Six Building Blocks.

Open the Design & Implement Guide to begin work toward achieving the following milestones.

This is a starting list of milestones for this stage, which you can adapt to your needs.

Building Block Activities
Leadership & consensus Leadership regularly emphasizes the importance of improving opioid management and solicits feedback during staff and clinician meetings Time is protected for improvement team to meet and work Safer and more cautious opioid prescribing has been discussed with clinicians and staff across the clinic, and there has been agreement in staff meetings that this is an area for improvement Clinical education opportunities offered to staff and clinicians, including on the science of chronic pain
Policies, patient agreements, & workflows Policies revised to align with evidence-based guidelines (e.g., CDC, AMDG) Patient agreement revised to support the policy and educate patients about risks Workflows written to support policies Training conducted on policies, agreement, workflows, and supporting EHR templates
Tracking & monitoring patient care Patients on long-term opioid therapy identified All clinicians and delegates signed up for the prescription data monitoring program Calculating MED as dose or medication changes is possible and easy for clinicians and staff There is a dashboard of key measures for all patients on long-term opioid therapy Data are used to monitor care gaps, high-risk patients, and clinical variation
Planned, patient-centered visits Data are used for pre-visit planning EHR pain visit templates are in place to cover key elements of the pain visit as outlined in the revised policy Standardized pre-visit planning and pain visits are integrated into the practice Patients receive education on chronic pain management and opioid risks Training in patient engagement is offered to staff and clinicians (e.g., motivational interviewing) Alternatives to opioids are regularly considered and discussed, and integrated into care processes
Caring for patients with complex needs Tools are selected and consistently in use to identify patients with complex needs (i.e., mental/behavioral health disorders, opioid use disorder, or other substance use disorders) Educational opportunities are provided to clinicians on how to identify and treat patients with opioid use disorder There is an approach to connecting patients to mental/behavioral health resources, either integrated in the primary care setting, in the community, or through telehealth There is an approach to connecting patients with opioid use disorder to treatment, either internally through waivered providers or externally through an identified medication for opioid use disorder treatment facility Confidentiality regulations and other information-sharing hurdles have been addressed so that patient information can be shared between medical, behavioral health, and substance use disorder clinicians Training is provided to clinicians and staff on overcoming stigma about patients with mental/behavioral health needs, opioid use disorder, and other substance use disorders
Measuring success Success metrics identified Success metrics regularly reviewed and reported at the clinician level

Building Block Activities

Leadership & consensus

Leadership regularly emphasizes the importance of improving opioid management and solicits feedback during staff and clinician meetings
Time is protected for improvement team to meet and work
Safer and more cautious opioid prescribing has been discussed with clinicians and staff across the clinic, and there has been agreement in staff meetings that this is an area for improvement
Clinical education opportunities offered to staff and clinicians, including on the science of chronic pain

Policies, patient agreements, & workflows

Policies revised to align with evidence-based guidelines (e.g., CDC, AMDG)
Patient agreement revised to support the policy and educate patients about risks
Workflows written to support policies
Training conducted on policies, agreement, workflows, and supporting EHR templates

Tracking & monitoring patient care

Patients on long-term opioid therapy identified
All clinicians and delegates signed up for the prescription data monitoring program
Calculating MED as dose or medication changes is possible and easy for clinicians and staff
There is a dashboard of key measures for all patients on long-term opioid therapy
Data are used to monitor care gaps, high-risk patients, and clinical variation

Planned, patient-centered visits

Data are used for pre-visit planning
EHR pain visit templates are in place to cover key elements of the pain visit as outlined in the revised policy
Standardized pre-visit planning and pain visits are integrated into the practice
Patients receive education on chronic pain management and opioid risks
Training in patient engagement is offered to staff and clinicians (e.g., motivational interviewing)
Alternatives to opioids are regularly considered and discussed, and integrated into care processes

Caring for patients with complex needs

Tools are selected and consistently in use to identify patients with complex needs (i.e., mental/behavioral health disorders, opioid use disorder, or other substance use disorders)
Educational opportunities are provided to clinicians on how to identify and treat patients with opioid use disorder
There is an approach to connecting patients to mental/behavioral health resources, either integrated in the primary care setting, in the community, or through telehealth
There is an approach to connecting patients with opioid use disorder to treatment, either internally through waivered providers or externally through an identified medication for opioid use disorder treatment facility
Confidentiality regulations and other information-sharing hurdles have been addressed so that patient information can be shared between medical, behavioral health, and substance use disorder clinicians
Training is provided to clinicians and staff on overcoming stigma about patients with mental/behavioral health needs, opioid use disorder, and other substance use disorders

Measuring success

Success metrics identified
Success metrics regularly reviewed and reported at the clinician level