Van Buren County Hospital Establishes an Outpatient Opioid Workgroup

Van Buren County Hospital (VBCH) is a twenty-five bed Critical Access facility located in Keosauqua, Iowa. The hospital also has four Rural Health Clinic sites located in Keosauqua, Birmingham, Farmington and Cantril, Iowa. During fiscal year 2023, they established an outpatient opioid workgroup. The concept of the group was developed after a risk assessment for compliance was completed. The facility recognized a need for better outpatient opioid prescription monitoring. It was determined that the group would be a multi-disciplinary team including a provider champion, pharmacy, quality, clinical informatics, and clinic leadership.
Once the team members were determined, goals were set. The group wanted to ensure that opioid prescriptions are optimized and utilized in a safe, effective manner by ensuring patients with opioid prescriptions have a guided plan to safeguard usage. Follow-up measures were put in place if it was noted these steps were not being completed. The group also wanted to educate staff and community members on safe opioid practices, with a special focus on Narcan, specifically obtaining a prescription, community availability and how to effectively use. The group also recognized the need to optimize features available in the Electronic Health Record (EHR) to assist clinicians with opioid care. EHR features utilized included renewal of pain contracts, appropriate testing, documentation of Narcan education, use of provider opioid dashboards and alerts within the EHR.
Once the group established goals, they began process improvement projects, to include a process to collect pain contracts by using their EHR reminder/prompts for providers; currently working to notify interdepartmental clinicians of patients with pain contracts. For every opioid prescription written a Prescription Drug Monitoring Program (PDMP) patient inquiry is completed.
Van Buren County was awarded community funds in relation to opioid crisis prevention. The opioid workgroup works closely with the sheriff’s office, public health, local school district, the Board of Supervisors and SAFE Coalition on community wide improvement efforts. This community partnership is looking to expand the number of drop boxes within the community, provide Narcan education to first responders and community members and expand the use of social media to provide opioid related education.
Through the process improvement work the group has noted more open communication on controlled substances and a standardized collection of pain agreements. Pain contract compliance started at 8% completion in July 2022 to 46% completion as of May 2023 with the goal to continue increasing compliance.
The group has utilized internal data to track progress for the outpatient population. This data includes tracking the percentage of patients with an opioid prescription who have an up-to-date pain contract on file and working with clinical staff to ensure expired opioid contracts are updated.
The group started out meeting weekly, then bi-weekly and now monthly as they have worked through process improvement activities. The workgroup has a standing agenda which includes monthly reports, clinical processes initiated with follow-up items, feedback from providers and frontline staff, updates from pharmacy, new functionalities within the EHR, and community involvement and education.
As the opioid workgroup continues to look forward, they are reviewing opioid related educational opportunities for clinicians. If others are looking to establish an opioid workgroup VBCH would recommend the group be multi-disciplinary, involve frontline staff in process changes, distinguish goals, track metrics, utilize EHR functionalities to help notify, remind, and support clinicians in safe practices and finally provide communication on goals and metrics in meeting huddles and through emails.

Reproduced with permission from Compass HQIC Network. This material was prepared by Compass HQIC Network a Hospital Quality Improvement Contractor under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. 12SOW Compass HQIC Network/Hospital Quality Improvement Contractor – [0335> – 06/28/2023.