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Feasibility of Safe Opioid Prescribing in Outpatient Palliative Care: A Quality Improvement Project
Margaret R Bauer1, Tracy Shamas1, Sarah Gillespie-Heyman1
1VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Background:
No guidelines for safe opioid prescribing in palliative care exist, which contributes to limited monitoring of opioid misuse in palliative care.
Measures:
Feasibility of a safe opioid prescribing standard operating protocol (SOP) was determined by assessing the percentage of patients in an outpatient cancer center who completed each component of a five-component SOP.
Intervention:
A five-component SOP included: risk stratification for misuse, consent form, prescription drug monitoring program review, urine drug testing, and Naloxone for high-risk individuals.
Outcomes:
After one year, compliance rates on four of the of the five-component SOP were greater or equal to 93%. Naloxone co-prescription for high-risk patients never reached over 78%, largely due to clinical decision not to co-prescribe if transition to hospice was imminent.
Conclusions/Lessons Learned:
Safe opioid prescribing measures are feasible in outpatient palliative care and can facilitate identification of individuals at risk for opioid misuse and prompt early interventions for misuse.
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