Feasibility of Implementing a Standard Operating Protocol for Safe Opioid Prescribing in Outpatient Palliative Care: A Quality Improvement Project (F425A)

Abstract

Objectives: 1 Summarize risk factors for opioid misuse 2 Describe key components of a standard operating protocol (SOP) for safe opioid prescribing in an outpatient palliative care program 3 Explain the process by which feasibility of SOP for opioid prescribing was determined Original Research Background: The misuse of opioids is a public health emergency Opioid guidelines exist for chronic pain, but not palliative care Lack of guidelines contribute to the absence of policies for opioid use in palliative care programs Research Objectives: 1) Establish an SOP for opioid prescribing in an outpatient palliative care clinic embedded in a VA cancer center;2) Determine feasibility of implementing each SOP measure over 9 months Methods: An SOP was created based on CDC/VA/DoD guidelines for opioid prescribing The SOP was implemented for non-hospice patients and included 6 components: 1 Completion of opioid consent;2 Baseline risk stratification for misuse;3 Urine toxicology every 6 months;4 Review State PMP every 3 months;5 Naloxone for individuals with high-risk score;6 Aberrant behavior plans Determined feasibility of each component by calculating completion rates after 3, 6, and 9 months Results: After 3 months (n = 43), completion rates of each SOP component were: opioid consent 91%, ORT 98%, CTPMP 77%, urine toxicology 65%, and Naloxone for 67% of high-risk cases After 6 months (n = 44): opioid consent 98%, ORT 100%, CTPMP 95%, urine toxicology 77%, and Naloxone 78% After 9 months (N = 48): opioid consent 94%, ORT 100%, CTPMP 98%, urine toxicology 79%, and Naloxone for 75% 100% of patients (n = 12) with unexpected urine Results had aberrant behavior plans Conclusion and Implications for Research, Policy, or Practice: An SOP for opioid prescribing in palliative care is feasible Completion rates for each component was >75% by 9 months, including 3 months during the COVID-19 pandemic with face-to-face restrictions SOP resulted in earlier identification of high-risk individuals, timelier interventions for misuse, and increased partnership with patients Future research is needed to determine the impact of opioid prescribing SOPs on misuse rates and implementation in non-VA settings