opioids

Quality Improvement Method May Improve Opioid Prescribing Workflow

Rheumatology clinics may be able to improve their opioid prescribing workflow if they use the Lean A3 quality improvement method, according to findings from a retrospective analysis.

“Lean A3 provides a rapid problem‐solving, team‐based approach to improve patient care,” the study authors wrote. “Lean A3 is based on a template of steps to guide a team of providers and staff through a workflow analysis that leads to problem identification, root cause analysis, and agreement on redesigned clinic workflows.”

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For the study, the researchers evaluated rheumatology records of individuals who had been prescribed opioids at least once from June 1, 2014, to May 31, 2017. 

The clinic developed a controlled substance visit protocol using the Lean A3 method to standardize 8 recommended elements of the opioid prescribing workflow, which include patient education, risk assessment, monitoring, and prescribing strategies.

Improvements were observed among most of the recommended elements; the only recommended element that did not change was the number of visits scheduled at least quarterly for patients prescribed long-term opioids.

Changes in recommended prescribing strategies and opioid prescribing volume included the following:

  • The percentage of signed patient consent to opioid treatment increased from 39% to 80%.
  • The percentage of treatment agreements increased from 39% completion to 78% completion.
  • The rate of risk assessment using the Current Opioid Misuse Measure increased from 0.5% to 76%.
  • Prescriptions that were written in 7-day increments to avoid weekend refill requests increased from 1% to 79%.
  • Urine testing increased from 1% to 32%.

The number of patients who were prescribed opioids decreased from 185 to 160. The annual prescription opioid morphine milligram equivalents (MME) also decreased from 1,933,585 to 1,386,368.

“The Lean A3 method is a successful quality improvement tool for improving and sustaining opioid prescribing within a single academic rheumatology clinic,” the researchers concluded. “This method has potential applicability to similar clinics interested in improving opioid prescribing.”

—Colleen Murphy

Reference:

van Eeghen C, Edwards M, Libman BS, MacLean CD, Kennedy AG. Order from chaos: an initiative to improve opioid prescribing in rheumatology using Lean A3 [published online September 3, 2019]. ACR Open Rheumatol. doi:10.1002/acr2.11078.