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Madigan program safely aids chronic pain sufferers

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Madigan Healthcare System has a sole-prescriber program for all chronic opioid prescriptions to assist medical providers in meeting the national standards of care, and to place patient safety at the forefront of pain management. The program highlights Madigan's efforts to ensure patients with chronic pain are monitored for safe use of medications that can be misused and accidentally overdosed.

Nationally, medical providers have dramatically increased their reliance on opioids to manage patients' pain.

"As medical providers prescribe more opioids for non-cancer pain, we need to do a better job of assessing risk and monitoring," said Nancy Poffenberger, a member of the Army's Pain Management Task Force and pharmacist at Madigan.

The Sole Prescriber Program, according to Poffenberger, requires a balance of not under prescribing or over prescribing opioids because nationally there are dual epidemics of under-treated and over-medicated pain.

"Medical providers have a responsibility to relieve pain and suffering, but we also are faced with a national epidemic of over use of opioids," said Poffenberger. "The solution is to provide additional treatment options besides opioids, assess the patient at risk of medication misuse or abuse, tailor the monitoring of opioids to the risk level of the patient, and show benefits in function and quality of life. Having universal precautions, such as a sole-prescriber, an opioid treatment agreement, a single pharmacy for prescriptions, and urine drug testing for compliance, minimizes risk of harm."

Any independently licensed medical provider at Madigan is qualified to be a sole-prescriber. This is usually the primary care manager unless another provider manages the patient's pain condition. The identity of the sole-prescriber is tracked through Madigan's prescription system and is listed in the electronic prescription ordering system to alert other members of the health care team of the provider who is responsible for prescribing chronic opioids.

"The purpose of the sole-prescriber program is to benefit the patient and increase safety in prescribing opioids," Poffenberger said. "The result is that patients with chronic pain have better continuity of care, less risk of medication interactions and less risk of overmedication. Our goal is to ensure opioid therapy is beneficial by helping patients live active lives despite chronic pain, rather than contributing to patients' health problems."

The program recommends that providers enter into a written Opioid Treatment Agreement with patients. This agreement outlines each patient's rights and responsibilities if they accept a treatment plan that includes opioids. Colonel Gary Clark, the Faculty Development Fellowship director and family medicine provider, is a sole-prescriber and believes the written agreement assists in many aspects of pain management.

"From a provider standpoint I think having a sole-prescriber ensures patients can't go to multiple providers and get narcotics. That keeps that commitment between me and the patient to stay on board with the same medication," Clark said. "When we have the written agreement the patient understands that there is a plan in place and it's in their best interest."

Clark believes the program assists with enhancing trust between the patient and the provider by helping the patient realize the purposes of pain medicines and underscores a commitment to pain management. With more than 100,000 patients at Madigan, the focus on safe, quality health care remains a priority. Assigning sole prescribers in managing high risk medications is just one of the steps Madigan institutes to ensure safety is the first priority.

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