When implementing quality standards, it is important to be mindful of the very real challenges to implementation such as time, resources, and culture. From my experience, one of the hardest challenges to overcome at any organization is culture, or in other words ‘the way we do things around here’.
It is important to find ways to change organizational culture to make necessary improvements in patient care. Disrupting the status quo is hard, but necessary to improve our health care system and ultimately our patients’ outcomes.
I joined the advisory committee that worked on developing the Opioid Prescribing for Chronic Pain Quality Standard because I saw a great need for safer opioid prescribing practices, but also wanted to ensure that opioids remained available for those living with chronic pain for whom they improve function and health related quality of life.
I was mindful not only of the opioid crisis characterized by escalating opioid death rates, but also of the epidemic of chronic pain that affects 1 in 5 Canadians, of whom 5% have severe pain-related disability.
Taking it one step at a time
When looking for areas for improvement, it is common for practitioners to feel overwhelmed with where to start. Quality Standards are helpful to inform practice and to reduce variability in care. There is always room for change and it’s okay to take it one step at a time.
For example, at the SickKids Chronic Pain Clinic where we actively engage in quality improvement, my colleagues and I reflected on the quality statements in the Opioid Prescribing for Chronic Pain Quality Standard and were confident that we were meeting those pertaining to pain assessment and treatment. However, as a team we saw an opportunity for change when considering statement number eight relating to the development of a prescription monitoring system.
Statement eight recommends that:
“Health care professionals who prescribe or dispense opioids have access to a real-time prescription monitoring system at the point of care. Prescription history is checked when opioids are prescribed and dispensed and every 3 to 6 months during long-term use, or more frequently if there are concerns regarding duplicate prescriptions, potentially harmful medication interactions, or diversion.”
We noticed that at our clinic we had very little information on our opioid prescribing practices. Our knowledge gaps included:
- How many opioid prescriptions were given a year
- How many patients were on opioids
- Whether providers in our clinic were prescribing opioids differently
- What opioids were being prescribed for
Prescription monitoring systems allow health care professionals to identify patterns of opioid and other monitored drug prescribing and reduce the potential for opioid diversion and polypharmacy.
As a result, we are using our newly implemented electronic medical record system to provide us with this much needed information. This system has given us the opportunity to begin tracking important prescribing information to learn about our processes and how to improve and standardize our care. I believe that our patients have benefited from this quality improvement initiative.
In case you missed them, below are Health Quality Ontario’s webinar series introducing Quality Standards related to opioid prescribing and opioid use disorder. Note, name and email address are needed to access the webinars.
Opioid Prescribing for Chronic Pain
Opioid Prescribing for Acute Pain
Opioid Use Disorder
Need help supporting your patients in managing their pain? Visit the Ontario Pain Management Resources website for a coordinated program of tools from partner organizations across the province.
Fiona Campbell BSc, MD, FRCA
Staff, Department of Anesthesia and Pain Medicine
Director, Chronic Pain Team
Co-director, SickKids Pain Centre
The Hospital for Sick Children, Toronto
Associate Professor, Department of Anaesthesia
Faculty of Medicine, University of Toronto
President, Canadian Pain Society
Please share your experiences implementing Quality Standards by taking one step at a time! Click on “Add a Comment” below.
This post is part of a series about how quality standards can be used to support quality improvement together with others who are working on adopting the quality standards. The introductory post can be found here.