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Analysis

Opioid Treatment: How Healthcare Providers Can Reduce Liability Risk

By Christopher Cheney  
   November 12, 2019

A new report focuses on the four steps in active pain management: screening and prescribing, dispensing and administering, monitoring and ongoing management, and tapering and discontinuance.

A new report from a national medical liability insurance company highlights how healthcare providers can reduce risks and improve patient safety in opioid treatments.

The human and economic costs of the country's opioid crisis have been severe. The Centers for Disease Control and Prevention says 700,000 people died in the  opioid epidemic from 1999 to 2017. The annual economic burden of prescription opioid misuse has been estimated at $78.5 billion, according to the National Institute on Drug Abuse.

The new report from Boston-based Coverys focuses on four steps in the process for active pain management: screening and prescribing, dispensing and administering, monitoring and ongoing management, and tapering and discontinuance. "Each step has associated risks that can contribute to opioid dependence and persistent use. Coverys malpractice events involving opioid adverse outcomes demonstrate that this process can break down at any step along the way."

The report features data collected from five years of closed claims that identified 165 patient events involving prescribed opioids. There are several key data points:

  • Opioids are most commonly prescribed for acute pain
     
  • 80% of indemnity payments were made for opioid prescriptions generated in inpatient hospital settings, emergency department surgical units, and physician practices
     
  • Chronic pain was the second highest driver of opioid prescriptions, with 60% of chronic pain events in the Coverys cases originating from physician practices or outpatient clinics
     
  • 39% of indemnity payments were associated with screening and prescribing
     
  • 29% of indemnity payments were associated with dispensing and administering
     
  • 31% of indemnity payments were associated with monitoring and management

Risk reduction recommendations

To manage risk, the first step for healthcare providers is to conduct an assessment to identify risk exposures and prioritize areas for improvement, the report says. "Assessment should include review of internal processes related to opioid screening and prescribing, dispensing and administration, monitoring and management, and discontinuance and prevention of drug diversion. Self-assessments will help identify organizational strengths, areas of opportunity to enhance patient care, and may reduce your potential liability."

The report makes four general recommendations for all steps in the pain management process:

  • Conduct ongoing patient assessments for risk factors and opioid therapy effectiveness.
     
  • Educate patients about opioid side effects—particularly addiction. Check your state's prescription drug monitoring program (PDMP) database for information on specific patients.
     
  • Perform screening and laboratory tests as indicated.
     
  • Document patient assessments, effectiveness of opioid treatment, results of PDMP reviews, test findings, and communications with patients and other treating clinicians.

The report includes specific recommendations for screening and prescribing, dispensing and administering, monitoring and management, and tapering and discontinuance. These specific recommendations were drawn from the Minnesota Opioid Prescribing Guidelines, the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, Federation of State Medical Boards, and Premier Safety Institute.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

The Centers for Disease Control and Prevention says 700,000 people died in the opioid epidemic from 1999 to 2017.

In a new medical liability report, 80% of indemnity payments were made for opioid prescriptions generated in inpatient hospital settings, emergency department surgical units, and physician practices.

To reduce liability risk, the first step for healthcare providers is conducting an assessment to identify risk exposures and prioritize areas for improvement.


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