7 Steps to Managing Prescriptions

What can we do?

A growing body of evidence reveals the benefits of a multimodality approach to chronic pain. In some instances, you may decide that judicious use of opioid narcotic analgesia should be part of a comprehensive management plan. We can take several steps to ensure safe analgesic prescribing as well as safe weaning and aftercare of those who have previously been on controlled analgesics.

Mr. Hawkins defaultClient Case: Mr. Hawkins

Mr. Hawkins notes that his inability to maintain activity for extended periods has led to an inability to maintain his work as a foreman for a local corporate construction company. He has had no other trauma or falls and denies weight loss, fever, other arthralgias, lower extremity weakness or in-coordination, or bowel and bladder dysfunction. He has had no other health problems and has no history of surgery. He takes no other medications but over-the-counter ibuprofen and has no medication allergies.

Gourlay et al identified 10 “universal precautions” for managing chronic pain with Opioids, and we have distilled those down to 7 key steps we should do with each and every patient. Always incorporate these 7 steps and you will be well on your way to a standardized approach to managing your patients, and to reducing the risk of misuse and abuse

  1. Determine Pain Etiology
  2. Perform Assessments
  3. Provide Prognosis and Obtain Informed Consent
  4. Discuss Treatment Options
  5. Create a Written Treatment Agreement
  6. Regularly Reassess Treatment
  7. Document Everything

Gourlay DL, Heit HA, Almahrezi A. Pain Medicine (2005) 6:107-12.

Let’s take a look at each of these steps in further detail and highlight related actions required by the new Title 844 Medical Licensing Board of Indiana Emergency Rule.