Healthcare Inspection: Management of Chronic Opioid Therapy at a VA Maine Healthcare System Community Based Outpatient Clinic.

摘要

The VA Office of Inspector General Office of Healthcare Inspections conducted an inspection to assess the merit of allegations made by a complainant concerning management of chronic opioid therapy at the VA Maine Healthcare System Community Based Outpatient Clinic (CBOC) in Calais, Maine. We reviewed the following allegations: Providers did not adequately assess patients who were prescribed opioids for chronic pain. Providers did not adequately monitor patients who were prescribed opioid medications for misuse or diversion of the medications. Facility managers asked providers to write opioid prescriptions for patients they had not assessed. We substantiated the allegation that providers did not adequately assess patients who were prescribed opioids for chronic pain. Although providers performed initial pain assessments of patients, reassessments were not consistently documented at the minimum required frequency. We substantiated the allegation that providers did not adequately monitor patients who were prescribed opioids for misuse or diversion of the medications. One provider did not properly follow-up on a patient's positive urine drug test, and due to staffing constraints at the CBOC, patients often obtained prescriptions from multiple providers. We substantiated the allegation that facility managers asked providers to write opioid prescriptions for patients whom the providers had not assessed; however, VHA regulations do not require a provider to see a patient before writing an opioid prescription. We recommended that the facility Director implement procedures to ensure that providers comply with all elements of management of chronic pain patients on opioid therapy at the Calais CBOC, including those highlighted in this report, as required by VHA and local policies. The Veterans Integrated Service Network and Facility Directors concurred with the recommendation and provided an acceptable action plan. We will follow up on the planned actions until they are completed.