5. Create a Written Treatment Agreement

Create a treatment agreement

treatment agreementJust as it is necessary to discuss prognosis, treatment options, and treatment effects, it is equally vital to lay out expectations for and of patients when the decision is made to include opioid analgesics as part of a treatment regimen, given the risks involved.

A written agreement of the expectations and obligations of both the patient and the practitioner can help set boundaries and provide a basis for detecting treatment problems early. The agreement should be explicit and detailed and include information about.

  • prescribing parameters (only one prescriber, limited day supply, no early refills, etc.),
  • drug monitoring (nature, type and how often),
  • adjunct therapies (type, e.g, physical therapy, mental health; requirements)
  • chronic pain management being participation based
  • repercussions of aberrant behavior and/or failure to comply with the agreement

If You Didn’t Document It, You Didn’t Do It

Discuss and document your entire treatment plan with the patient, noting that no one therapeutic entity will manage their condition. Set up expectations that the patient should comply with the plan as a whole, rather than a single aspect such as pharmaceutical therapy.

This documentation should be done initially and periodically thereafter, not less often than yearly. Documentation should be signed, if possible.  Reading aloud and discussing the specifics with patients in a face-to-face setting is ideal as patients can ask questions and these conversations can help mitigate the problems of poor reading comprehension or health literacy of some patients.

Mr. Hawkins defaultClient Case: Mr. Hawkins

As with informed consent, these issues should be discussed with the patient to ensure understanding and agreement with the treatment.

Knowledge Check

When should Mr. Hawkins return?

a. When he needs a refill on his medicines b. Every 6 months for re-evaluation c. In 1 month d. On an as needed basis