Implementing Best Practices Through Policy: Keeping Patients on Chronic Opioid Therapy Safe in Primary Care.

Abstract

Background: The Centers for Disease Control and Prevention opioid prescribing guidelines for chronic pain were developed to combat morbidity and mortality associated with the escalating opioid crisis; however, implementing these guidelines is challenging. Clinic policies focused on treatment recommendations for chronic opioid therapy (COT) are needed to assist clinicians in safely managing pain. The purpose of this quality improvement project was to assess whether the implementation of a COT clinic policy improved provider adherence to evidence-based opioid prescribing guidelines based on state regulations in a nurse-led primary care clinic. Objectives: This project aimed to establish chronic opioid management best practices to improve provider adherence to state guidelines in a nurse-led primary care clinic. Methods: A quasi-experimental pre-post-intervention design was utilized with a sample of five providers and 33 COT patients. Results: Paired-sample t tests were used to assess the effect of COT policy implementation. Overall, no statistically significant differences were noted; however, policy implementation resulted in improved documentation of six key COT measures. Medium effect sizes were observed for completed opioid contracts (Cohen's d = .43), utilization of nonopioid pain therapies (d = .36), and urine drug screens (d = .39), indicating a moderate impact of the intervention in these areas. Conclusions: The findings suggest that education and implementation of a clinic opioid policy in primary care practice are effective in meeting evidence-based practice guidelines for COT. The importance of broad stakeholder engagement and ongoing support for policy adoption was highlighted. Nursing Implications: This project provides valuable insights into improving the safety of pain management in primary care to improve prescribing practices and mitigate risks associated with COT.