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Opioid Management Practice Concerns, John J. Pershing VA Medical Center Popular Bluff, Missouri

Report Information

Issue Date
Report Number
16-01077-255
VISN
State
Missouri
District
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Hotline Healthcare Inspection
Recommendations
8
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG conducted an inspection to evaluate allegations regarding opioid management practices at the John J. Pershing VA Medical Center (facility), Poplar Bluff, MO. Allegations included: Long-term opioid therapy for pain was poorly managed for certain patients; Opioid prescriptions were written for patients without documentation of an opioid risk stratification tool, such as the opioid risk tool (ORT); Some providers did not consistently use urine drug screening (UDS), order confirmatory tests to evaluate for diversion, or further evaluate UDS results that were suggestive of urine tampering; and Opioid pain care agreements, including signed informed consents, were not consistently completed prior to initiating long-term opioid therapy for pain. We substantiated poor management of long-term opioid pain therapy for 10 patients. We found documentation for the condition requiring opioid therapy but did not find risk evaluation when clinically significant changes to a patient’s health status occurred. We found that a provider lacked knowledge of safe and effective methods for tapering patients’ opioids. We substantiated that opioid prescriptions were written for patients without documentation of an opioid risk stratification tool such as ORT. The Veterans Health Administration’s Opioid Safety Initiative provides guidelines to develop tools to identify high-risk patients. Using the ORT helps a provider risk stratify patients for initiating or continuing opioid therapy, and the ORT can help guide providers in determining the frequency of obtaining UDS for patients on long-term opioid therapy for pain. We substantiated that some providers did not consistently use UDS, order confirmatory tests to evaluate for diversion, or further evaluate UDS results that were suggestive of urine tampering for the patients reviewed. We substantiated that some patients did not have signed informed consents prior to initiating long-term opioid therapy for pain. We recommended that the Facility Director ensure that relevant providers complete timely patient evaluations; receive education on dual short acting opioids and tapering of opioids; review Veterans Health Administration recommendations regarding the use of opioid risk stratification tools; order UDS frequency based on risk assessment and complete UDS at least annually; consistently use UDS confirmatory testing; and consistently complete the informed consent process prior to initiating long-term opioid therapy for pain. We also recommended that the Facility Director ensure that reviews of the identified patients’ cases are completed and develop processes to minimize the potential for UDS tampering.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director develop processes to ensure that the relevant providers complete timely patient evaluations for continued long-term opioid therapy for pain based on clinically significant changes or findings to a patient’s health status.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that reviews of the cases of the identified patients with clinically significant changes are completed and take action as appropriate.
No. 3
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that the relevant providers receive education on the concurrent prescribing of dual short acting opioids and tapering of opioids.
No. 4
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that the relevant providers review Veterans Health Administration recommendations regarding the use of opioid risk stratification tools, such as the Opioid Risk Tool, to identify high-risk patients for longterm opioid therapy for pain.
No. 5
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that the relevant providers order urine drug screening frequency based on risk assessment and complete urine drug screening at least annually.
No. 6
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that the relevant providers consistently use urine drug screening confirmatory testing.
No. 7
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director develop processes that minimize the potential for urine drug screening tampering.
No. 8
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Facility Director ensure that the relevant providers consistently complete the informed consent process prior to initiating long-term opioid therapy for pain as specified by Veterans Health Administration policy.