Summit Medical Group- Policy and Procedure Manual

Policy #:ADM -

Policy Title:Controlled Substance Abuser

Effective Date: XX, XX, 2009

Policy and Procedure

Department: Clinical Services / Cross Reference:
Title: Controlled Substance Abuser: Identification and Communication / Policy #:
Effective: 05/xx/10 / Supersedes: None
Revised Date:

1.0Purpose:

1.1To establish a standard protocol for identifying and communicating among SMG providers regarding patient’s with potential drug seeking behavior and to reduce the incidence of drug diversion.

2.0Statement of Policy: it is the policy of the Summit Medical Group to:

2.1To identify, communicate and treat drug seeking patient behavior in a consistent, timely and standard manner

3.0Objective

3.1Improved communication for identification of drug seeking patient

3.2 Reduce abuse and diversion

4.0Procedure

4.1Identification and Risk Stratification:

4.2When staff becomes aware of a patient with potential drug seeking behavior provider communication should immediately occur, patient triage and the “common characteristics of the substance abuser” noted below reviewed and implemented as appropriate.

4.3Identifying Characteristics of the Substance Abuser1

4.3.1.1Unusual behavior in the waiting room

4.3.1.2Assertive personality, often demanding immediate action

4.3.1.3Unusual appearance-extremes of either slovenliness or being over-dressed

4.3.1.4May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history

4.3.1.5Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance

4.3.1.6Will often request a specific controlled drug and is reluctant to try a different drug

4.3.1.7Generally has no interest in diagnosis - fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation

4.3.1.8May exaggerate medical problems and/or simulate symptoms

4.4Refer to Clinical Guidelines for management of the controlled substance abuser for further patient management.

5.0Documentation

  • 5.1 When a patient has been identified as a controlled substance abuser the primary prescribing provider or SMG provider identifying controlled substance abuser(if PPP is not in SMG) shall place an alert in the electronic medical record by completing the following procedure:
  • Click thei on the Patient Banner, and then click Add Alert.
  • Select apre-definedalert from the Available Items list or enter a free text alert in the Adhoc Alert box, then click OK.
  • A total of 3 Chart Alertscan appear on the Clinical Toolbar

5.2 When it has been determined that the patient no longer requires such an alert the primary prescribing provider shall remove the alert in the electronic medical record by performing the same procedure as above, but deleting the text, as well as documenting the rationale for the same in the medical record.

6.0Off-Hours Patient Identification and Referral

6.1 Should a patient present off hours to UCC and/or On-Call that appears suspect to drug seeking behavior, the provider will supply the patient with just enough medication allowing reasonable time until an appointment with their primary prescribing provider can be made.

6.2 The UCC or On-Call provider will task the patients primary prescribing provider of the events and recommendation for assessment.

7.0Responsible Party

7.1 The Chief Medical Officer is responsible for the implementation of and compliance with this policy.

8.0Review

8.1 This policy will be reviewed annually by Clinical Council for recommendations, revision and approval.

9.0Approvals

______
Submitted By: (Insert Name/Title) / ______Date
______
(Insert Name/Title) / ______
Date
______
(Insert Name/Title) / ______
Date

1

1 The Office of Diversion Control.

2 Gourlay DL, Heit HA, Almahrezi A. Universal Precautions in Pain medicine: A Rational Approach to the Treatment of Chronic Pain. Pain Med. 2005; 6(2):107-112. King Pharmaceuticals 2009