Vital Times 2017 - 65

In addressing the opioid epidemic and to mitigate
opioid related adverse events, the Center for Disease
Control (CDC) published practice guidelines in March
of 2016 recommending that health care providers
identify patients at high-risk for opioid overdose, and
provide these patients and their families with education
and prescriptions of naloxone opioid rescue-therapy
(ORT). Within the University of California, Irvine
(UCI) chronic pain management outpatient center,
we conducted a study to determine whether our
own academic pain physicians were compliant with
these CDC guidelines for opioid prescribing, patient
education and naloxone ORT in high-risk patients.
Data was collected on previous naloxone prescriptions
provided by UCI chronic pain physicians prior to an
intervention. The intervention was identification of
patients at high-risk for opioid abuse, and provision
of naloxone ORT education and prescriptions.
Pre and post-intervention surveys were collected
regarding naloxone prescribing habits and our results
demonstrated statistically significant improvement in
naloxone education and naloxone ORT prescribing. The
results of the study were presented at the 2017 American
Society of Anesthesiologists conference in Boston and
demonstrated improvement in compliance with CDC
guidelines in identifying high-risk opioid patients and
providing naloxone education and prescription ORT
post intervention.
With this study, we were able to not only identify our
own practicing habits as chronic pain physicians, but we
also became more aware of our high-risk opioid patients
and began to practice safer prescribing habits. In light of
the opioid epidemic, other clinics and institutions may
consider their own studies to identify their own highrisk opioid patients and opioid/naloxone prescribing
habits and to be able to apply it to their own institutions
for safer pain management practices. At the end of
the day, our goal as pain physicians is to provide pain
management without causing further harm to our
patients, as such, it is important for us to understand our
own institutional practices and to work from within to
provide better patient care.

Is Your Hospital Ready? New Guidelines
and Accreditation Standards in Effect
January 2018
Accreditation agencies such as The Joint Commission
and patient satisfaction surveyors such as Press Ganey
have evolved in light of this epidemic and are more
reflective of the communication of pain, and preventing
and monitoring for adverse events related to opioid
morbidity.
1. The Joint Commission: New joint commission
standards on pain will be effective January 2018. The
standards move away from the "5th vital sign" and
towards identification of high-risk individuals, creating
an institutional Pain Committee and an institutional
leader in Pain Management, as well as reviewing opioidrelated adverse events for quality improvement.
2. Press Ganey and HCAHPS: CMS finalized the
proposal to remove the Pain Management dimension
from the Hospital Value Based Purchasing (VBP)
program, beginning with the 2018 fiscal year payment
and based on discharges from calendar year 2016. For
the past two years, Press Ganey has been an active
participant in the ongoing dialogue at CMS on this
topic. Per CMS' goals, removing the pain management
questions from VBP calculations will eliminate any
perception that clinicians may feel financial pressure
to overprescribe pain medications, despite there being
no empirical evidence of this effect. Press Ganey
supports CMS' decision to finalize the proposal, which
eliminates the debate around the impact of these
questions and allows us to focus on the important work
of advancing more patient-centered care. Although the
Pain Management dimension will be removed from the
payment calculation, CMS will continue to include pain
management questions on the HCAHPS survey. CMS
recently released alternative pain management questions
which they are evaluating that cover two domains, Pain
during Stay Domain and Treating Pain Post Discharge
Domain.
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