Graduated medical doctors advance from classwork and clinical rotations into the world of residency programs. Here they expand their skills by practicing alongside experienced providers. The set of six medical residents who rotate into the Family Medicine Residency (FMR) in Rapid City, SD, gain experience in a wide variety of primary and specialty care opportunities, including a pain management clinic.
Opioid addiction and overdose are an ongoing concern for the region and policies for managing chronic pain using alternative therapies, immediate release -vs- extended release and lowest dose options are standards at FMR. When South Dakota implemented a Prescription Drug Monitoring Program (PDMP) in 2010, the residency program took notice and developed new policies within the existing chronic pain clinic.
“All residents need to register with the drug monitoring system and use it regularly. We exhaust all non-narcotic management options before initiating a trial of narcotics. We also engage the residents in quality improvement reviews,” shared Kathy Jedlicka, RN, patient care coordinator.
Beginning in August 2013, FMR added an extensive pain agreement and urine drug screening protocols for all FMR chronic pain patients using controlled medications. Patients review and sign the agreement along with the provider before medication is prescribed. As of February 2018, 70 percent of chronic pain patients receiving controlled medications from FMR have a documented pain agreement and 76 percent have at least one urine drug screening.
“I spend a lot of time with the patient describing the conditions of the pain agreement. We talk about the physical dependency, potential for addiction and overdose, side effects, risks and medication disposal,” explained Jedlicka.
The pain agreement is shared with other providers and prescriptions are limited to one provider, one pharmacy with no early or Friday refills allowed.
Jedlicka commented, “The pain agreement includes some harsh criteria, but they are fair guidelines to protect patients and others from misuse of these chronic pain medications.”
In 2017, the Centers for Disease Control and Prevention (CDC) released 12 key recommendations for improving practices related to prescribing opioids for chronic pain and FMR revised the program to meet the criteria. FMR developed prescribing guidelines and PDMP registration requirements, moving the participation rate from around 20 percent to 90 percent in just over a year.
Their pain management practices were featured in a webinar titled Chronic Pain Management at a Family Medicine Residency hosted by the Great Plains Quality Innovation Network on February 6, 2018. The presentation is part of an ongoing series on pain management. The next webinar in the series will be A Statewide Pain Management Guidance Document: A Provider and Community Resource scheduled from 12:15 – 1:15 pm on April 10. Learn more about the Great Plains QIN medication safety initiative,including training, tools and resources on the Web site.