{"id":114,"date":"2018-02-27T05:13:35","date_gmt":"2018-02-27T05:13:35","guid":{"rendered":"http:\/\/www.depts.washington.edu\/fammed\/improvingopioidcare\/?page_id=114"},"modified":"2021-05-18T18:15:13","modified_gmt":"2021-05-18T18:15:13","slug":"stage-2-design-implement","status":"publish","type":"page","link":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/implementation-guide\/stage-2-design-implement\/","title":{"rendered":"Stage 2: Design &amp; Implement"},"content":{"rendered":"<p>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.<\/p>\n<p>Open the <strong><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/10\/6bb-guide-stage2-designandimplement.pdf\">Design &amp; Implement Guide<\/a><\/strong> to begin work toward achieving the following milestones.<\/p>\n<p><em>This is a starting list of milestones for this stage, which you can adapt to your needs.<\/em><\/p>\n<div class=\"table-responsive\">\n<table class=\"table assessment-table\">\n<thead>\n<tr>\n<th><strong>Building Block Activities<\/strong><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><strong>Leadership &amp; consensus<\/strong><\/p>\n<ul>\n<li>Leadership regularly emphasizes the importance of improving opioid management and solicits feedback during staff and clinician meetings<\/li>\n<li>Time is protected for improvement team to meet and work<\/li>\n<li>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<\/li>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/10\/Clinical-Education-Opportunities-on-Opioids_2020-10-26.pdf\">Clinical education opportunities<\/a> offered to staff and clinicians, including on\u00a0<a href=\"https:\/\/www.oregonpainguidance.org\/clinics\/opmc-online-pain-management-course\/\">the science of chronic pain<\/a><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><strong>Policies, patient agreements, &amp; workflows<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/01\/Model-opioid-prescribing-policy_2021-01-04.docx\">Policies<\/a>\u00a0revised to align with evidence-based guidelines (e.g., <a href=\"https:\/\/www.cdc.gov\/drugoverdose\/prescribing\/guideline.html\">CDC<\/a>, <a href=\"http:\/\/agencymeddirectors.wa.gov\/Files\/2015AMDGOpioidGuideline.pdf\">AMDG<\/a>)<\/li>\n<li><a href=\"http:\/\/Model-opioid-prescribing-patient-agreement_2021-04-01\" data-wplink-url-error=\"true\">Patient agreement<\/a>\u00a0revised to support the policy and educate patients about risks<\/li>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/01\/Chronic-Pain-Appointment-Workflow_2021-01-12.pdf\">Workflows<\/a>\u00a0written to support policies<\/li>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2019\/09\/Training-and-Rollout_attribution.pdf\">Training<\/a> conducted on policies, agreement, workflows, and supporting EHR templates<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><strong>Tracking &amp; monitoring patient care<\/strong><\/p>\n<ul>\n<li>Patients on long-term opioid therapy <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/07\/Approaches-to-identifying-patients_2020-07-30.pdf\">identified<\/a><\/li>\n<li>All clinicians and delegates signed up for the <a href=\"http:\/\/www.pdmpassist.org\/content\/state-pdmp-websites\">prescription data monitoring program<\/a><\/li>\n<li>Calculating\u00a0<a href=\"http:\/\/www.agencymeddirectors.wa.gov\/calculator\/dosecalculator.htm\">MED<\/a>\u00a0as dose or medication changes is possible and easy for clinicians and staff<\/li>\n<li>There is a <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/09\/Developing-a-tracking-and-monitoring-dashboard.pdf\">dashboard<\/a> of <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2019\/09\/Data-to-consider-tracking_attribution.docx\">key measures<\/a> for all patients on long-term opioid therapy<\/li>\n<li>Data are used to monitor care gaps, high-risk patients, and clinical variation<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><strong>Planned, patient-centered visits<\/strong><\/p>\n<ul>\n<li>Data are used for pre-visit planning<\/li>\n<li>EHR pain visit <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2018\/02\/PainTracker_PatientVersion.pdf\">templates<\/a> are in place to cover <a href=\"\/improvingopioidcare\/helpful-resources\/recommended-assessments\/\">key elements of the pain visit<\/a> as outlined in the revised policy<\/li>\n<li>Standardized <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/01\/Chronic-Pain-Appointment-Workflow_2021-01-12.pdf\">pre-visit planning<\/a> and <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/10\/Suggested-opioid-management-assessment-schedule_2020-10-26.pdf\">pain visits<\/a> are integrated into the practice<\/li>\n<li>Patients receive <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/10\/Education-Resources-for-Patients-with-Chronic-Pain_2020-10-19.pdf\">education<\/a> on <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2019\/09\/Chronic-Pain-Self-Management-Resources_2019-05-02-w-attribution.pdf\">chronic pain management<\/a> and opioid risks<\/li>\n<li>Training in <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2020\/07\/Empathic-Communication-Resources_2020-07-28.pdf\">patient engagement<\/a> is offered to <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2019\/09\/Difficult-Conversations-for-Staff_2018-09-19-w-attribution.pdf\">staff<\/a> and <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2018\/02\/Principles-and-language-suggestions-for-talking-with-patients.pdf\">clinicians<\/a> (e.g., motivational interviewing)<\/li>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2018\/10\/nonopioid_treatments-a.pdf\">Alternatives<\/a> to opioids are regularly considered and discussed, and integrated into care processes<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><strong>Caring for patients with complex needs<br \/>\n<\/strong><\/p>\n<ul>\n<li><a href=\"\/improvingopioidcare\/helpful-resources\/recommended-assessments\/\">Tools<\/a> are selected and consistently in use to identify patients with complex needs (i.e., mental\/behavioral health disorders, <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/01\/OUD-diagnosis-form_2020-12-29.pdf\">opioid use disorder<\/a>, or other substance use disorders)<\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/drugoverdose\/training\/oud\/index.html\">Educational <\/a><a href=\"https:\/\/cmeregistration.hms.harvard.edu\/events\/identification-counseling-and-treatment-of-oud\/event-summary-fdaa0a8f057049f5821fce69c22ca9c2.aspx?dvce=1\">opportunities<\/a> <a href=\"https:\/\/www.youtube.com\/watch?v=IgfC92R-Ya4\">are<\/a> provided to clinicians on how to identify and treat patients with opioid use disorder<\/li>\n<li>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<\/li>\n<li>There is an approach to connecting patients with opioid use disorder to treatment, either <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/01\/BuprenorphineProgram-in-PrimaryCare_2021-01-12-1.pdf\">internally<\/a> through <a href=\"https:\/\/learning.pcssnow.org\/p\/onlinematwaiver\">waivered<\/a> providers or <a href=\"https:\/\/www.samhsa.gov\/medication-assisted-treatment\/find-treatment\">externally<\/a> through an identified medication for opioid use disorder treatment facility<\/li>\n<li>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<\/li>\n<li>Training is provided to clinicians and staff on <a href=\"https:\/\/www.albertahealthservices.ca\/assets\/info\/hrs\/if-hrs-reducing-stigma.pdf\">overcoming<\/a> <a href=\"https:\/\/americanhealth.jhu.edu\/article\/guiding-principles-addressing-stigma-opioid-addiction\">stigma<\/a> about patients with mental\/behavioral health needs, opioid use disorder, and other substance use disorders<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td><strong>Measuring success<\/strong><\/p>\n<ul>\n<li><a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-content\/uploads\/sites\/9\/2021\/02\/Measuring-success-metrics_2021-02-18.pdf\">Success metrics identified<\/a><\/li>\n<li>Success metrics regularly reviewed and reported at the clinician level<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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 &hellip; <a href=\"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/implementation-guide\/stage-2-design-implement\/\">Continued<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-section.php","meta":{"footnotes":""},"class_list":["post-114","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/pages\/114","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/comments?post=114"}],"version-history":[{"count":34,"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/pages\/114\/revisions"}],"predecessor-version":[{"id":1931,"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/pages\/114\/revisions\/1931"}],"up":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/pages\/8"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/improvingopioidcare\/wp-json\/wp\/v2\/media?parent=114"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}