CODE: Chronic Opioid Documentation Evaluation

Abstract

Objectives 1. Describe an algorithm for the use of opioids in chronic pain, including key components of initial and follow-up visits. 2. Describe the data supporting screening tools regarding opioid risks and teach learners how to complete them. 3. Practice key communication tasks relevant to chronic opioid therapy. Background.Aspatientswithall typesof life-threatening illnesses live longer, palliative care clinics are increasingly tasked with the management of chronic pain with opioids. Because this has traditionally been the domain of other specialties, hospice and palliative medicine (HPM) fellowships may not have the tools to effectively train their fellows in the proper use of opioids for chronic pain. Tomeet this need, chronic opioid documentation evaluation (CODE) was developed. CODE engages the learner by using chart review of their own patients to highlight knowledge gaps and facilitate instruction. After attending adidactic session, reviewing consensus guidelines, and completing an online module, the learner reviews their patient’s chart and attempts to complete several validated chronic pain tools such as the Brief Pain Inventory and the Opioid Risk Tool, noting any deficiencies in their documentation. The learner presents a plan of care based on this chart review to the faculty member who then uses informal role play to help the fellow with any difficult communication tasks they are likely to encounter based on their plan. Methods. CODE was initially designed for internal medicine residents but, based on requests from fellows, it was adapted for inclusion in our HPM fellowship. Its design is based on a search of the literature and recent consensus guidelines for the management of chronic pain. Results. Initial feedback has been extremely positive. Data from a ‘‘knowledge and attitudes’’ survey and an evaluation of the session from the initial three HPM fellows and approximately 20 medicine residents will be presented. Discussion. By using chart review of the learner’s own patients in conjunction with standardized chronic pain tools, CODE makes teaching points obvious and relevant. Collaborative development of a plan of care and informal role play makes the lessons instantly applicable. CODE can be easily adopted at other sites and can help reduce the discomfort trainees feel with these sometimes difficult encounters. Conclusion. CODE is an effective and engaging method for training HPM fellows in the appropriate use of opioids for chronic pain in the outpatient palliative care setting.