SHASTA COMMUNITY HEALTH CENTER
Policy: Opioid Pain Management
Procedures
Effective Date: November 22, 2005
Number of Pages: 3
JCAHO Standards (if applicable):
Standard RI.2.160
Standard PC 8.10
Reviewed/Approved By:
Medical Directors
SCHC Board of Directors
I.
Manual: Medical Staff
Revision Date:
Number of Forms: 2
Saved As: Opioid Pain Management
Procedures 12.07.doc
Reviewed/Approved Date:
Policy:
It is the policy of Shasta Community Health Center to assure appropriate clinical
management of patients with chronic pain on opioid drug therapy. This policy
shall apply to those utilizing opioids a majority of days in a 3 month period.
II.
Purpose/Goal:
The purpose of this policy is to delineate clinician responsibilities, approved tools
and standard documents for managing patients with chronic pain on opioid drug
therapy.
III.
Procedure:
A. Organization
1. The Pain Management Committee shall be a standing committee of the
medical staff, meeting monthly, composed of up to six clinicians from
various departments and the Director of Quality Improvement.
2. At least one member of the Pain Management Committee shall be from
the Primary Care Neuropsychiatry Department, and at least one shall be
from a satellite clinic.
3. The Pain Management Committee is charged with the following
responsibilities:
a. Develop clinic-wide policies regarding chronic pain management.
b. Recommend, review and revise clinical tools, documentation forms
and standard letters for the management of chronic pain.
c. Act as a clinical resource group for clinicians in the management of
chronic pain.
d. Periodic audits to measure compliance, uniformity and adherence to
policy
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B. Basic Pain Management processes for clinicians:
1. At the time of the initial visit, the clinician shall see and assess the patient
for chronic pain issues. A full assessment includes an appropriate systembased physical exam, appropriate diagnostic testing as indicated, a review
of the past medical history, and completion of the “Brief Pain Inventory”
filed in left side of chart progress notes. Other resources such as a check of
the California Department of Justice CURES Program for past medication
history or contacting the patient’s previous clinician may also be utilized.
2. After the assessment has been completed, the clinician shall make a
decision regarding treatment of the patient based on the assessment and
his/her best clinical judgment.
3. If the decision is to provide primary care and to begin or continue
management of chronic pain using controlled substances, the clinician
shall educate the patient regarding the practices and policies of Shasta
Community Health Center, and the patient will be expected to sign a
“Medication Management Agreement”.
4. In some cases, and always based on the assessment and review of
documentation, the clinician may agree to provide primary care but not
controlled substances, and will notify the patient of that limitation.
5. Ongoing management of chronic pain:
a. At each visit, the clinician should assess the patient response to
treatment, with attention to severity of pain, response to treatment,
quality of sleep and potential medication side effects.
b. At least once each year, the patient will be asked to provide a urine
specimen for toxicology screening purposes. If the clinician has any
concerns about the possibility of adulteration of the urine sample, s/he
may request that a member of the nursing staff supervise while the
specimen is obtained; if the patient is unable to void a catheterized
specimen may be obtained with patient permission. If patient fails to
comply with requested urine sample, the clinician may decline to
provide opioid medication.
c. Bi-annually or more frequently at clinician discretion, Brief Pain
Inventory to be completed.
C. Problems during the pain management process:
1. Toxicology screens positive for illegal substances or for medications that
the patient has not been prescribed – the clinician has the option to stop
prescribing controlled substances. In that case, the findings of the
toxicology screen shall be discussed with the patient and the rationale for
not prescribing explained. A letter documenting the rationale for not
prescribing shall be sent to the patient and a copy placed in the medical
record.
2. Behavior issues – the clinician may ask the patient to sign a behavior
agreement or make a referral to the Case Review Committee.
3. Clinical management of chronic pain – the clinician may present the
patient’s case to the Pain Management Committee for advice.
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4. In all cases in which it seems the most appropriate action is to discharge
the patient from SCHC, the case must be referred to Case Review
Committee using the normal referral process unless the clinician believes
there is a high potential risk to employees or other patients; in the latter
case, a request for an expedited discharge may be requested by
communicating with the chair of the Case Review Committee.
IV.
Forms
A. Shasta Community Health Center Brief Pain Inventory
B. Letter notification, “SCHC Will No Longer Prescribe You With Controlled
Substance Medications.”
V.
VI.
Written by:
SCHC Pain Management Committee 11/7/05
References:
A. Medical Boards of California Guidelines for Prescribing Controlled
Substances for Pain.
B. California Academy of Family Physicians
C. Patient Activity Report (PAR) California Department of Justice form BNE
1177 (07/2003)
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