A Process to Self-Audit Opioid Prescribing Practices in Skilled Nursing Facility Patients

Abstract

Background: Opioid medications are associated with adverse events, particularly falls and consequent injury, in elders, including those in the long term care setting. However, uncontrolled pain is also a major issue in long term care. A single, 182-bed skilled nursing facility associated with a tertiary academic medical center. All long-term residents (short-term rehabilitation residents were excluded) who resided at the skilled nursing facility between July 1st and September 30th, 2013. Objective/Aim: To describe a quick and reproducible process by which long term care providers can self-audit their opioid prescribing practices in long term care patients. Quality Improvement Methods: Data regarding individual provider opioid prescribing practices in Medicare Part D patients, reported as a percentage (frequency), was obtained from the ProPublica website (propublica.org). Review of the skilled nursing facility’s electronic medical record (Point Click Care) was completed to determine frequency of opioid use by the same providers in their long term care patients. The two data sets were compared to determine correlation. Results: 38.7% (36/93) of long term care patients examined were prescribed at least one opioid medication. Rates of opioid use in long term care patients per provider ranged from 36.7% to 42.4%. Rates of opioid use in Medicare Part D patients for the same providers ranged from 11% to 13%, with a ratio of opioid prescription frequency in long term care versus Medicare Part D patients of approximately 3:1 for all providers. Conclusion: Opioid prescribing frequency differs significantly based on the patient population considered, with frequency of opioid use significantly higher in long term care versus all Medicare Part D patients. In this small study, frequency of opioid use in the long term care setting was approximately three times that in all Medicare Part D patients, and this ratio was consistent across all prescribers examined. If confirmed in a larger study, this would indicate that ProPublica data represents a quick, efficient metric by which providers can estimate their frequency of opioid use in long term care patients, which is not readily accomplished with many current long term care medical records. Increased awareness of one’s opioid prescribing practices may lead to more thoughtful opioid use, with improved patient quality and safety. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.