Chronic Pain Management Workflow Getting Started: Wrenching In Assessments into Favorites (do once!)

Transcription

1 Chronic Pain Management Workflow Getting Started: Wrenching In Assessments into Favorites (do once!) 1. Click More Activities to star flowsheets into your chunky button screen. 3. Use the search function to wrench in assessments. 2. Click on the flowsheet tab to open a new flowsheet. TIP: Click override template order to add new assessments. You will need to add each assessment individually.

2 4. Type pain in the search box. Add the 4As Pain Assessment and click accept. You can also add the ORT, DAST, and DIRE by searching pain. Tip: Use the arrow buttons to reorder your flowsheets. Note: You will not use every assessment each time you see a patient but wrenching them all at 2 once will save time in the future.

3 5. Search for the GAD, PHQ, and AUDIT individually and click accept to add the assessment to your flow sheet. Add the following assessments to your flow sheet: 4-As Assessment (patient completed*) AUDIT (AMB AUDIT ALCOHOL USE SCREEN) (patient completed) PHQ-9 (patient completed) GAD-7 (patient completed) DAST-10 (patient completed) Opioid Risk Tool (provider completed) DIRE (provider completed) *Except the 2 provider answered questions Remember: You must add each assessment individually. 3

4 Completing the Assessments 1. Use the tabs to scroll through the assessments. TIP: Make sure the tab is open in order to click through the scoring. Click on the arrow to open the window. 2. Select the scores by typing them in OR by clicking on the appropriate answer in the pull down bar. Reminder: Be sure to hit file after entering each assessment. Reminder: The patient completes the following assessments independently: 4-As* PHQ GAD DAST AUDIT-C The scores will need to be manually entered into EPIC. *2 questions in the 4-As will be answered by the provider 4

5 3. Providers must answer the percentage of pain relief and the Query to Clinician 4. The total scores will populate at the bottom of each subsection. 5. Add the date of the last PDMP check and the date of the last urine drug screen in the Assessment section. 6. To add a patient to the narcotics registry click yes or no at the bottom of the 4As assessment. TIP: Refer to the Row Information for guidance on when to include the patient in the registry. 5

6 7. DAST-10: Select Yes or No based on patient s completed report. TIP: Refer to the Group Information box for information on how to interpret the score. 8. AUDIT: Input answers based on patient s completed report. 9. Opioid Risk Tool: Provider completes with the patient. The ORT is designed for Opioid naive patients but may be instructional for current users. 6

7 10. DIRE: Provider completes with the patient. Use the drop down in the right tab to choose the appropriate score. TIP: Leave the R blank. The risk will automatically calculate based on the other scores. TIP: Row Information has tips on how to interpret the score. 7

8 Creating a new note for a Comprehensive Visit 1. Click on the carrot to create a blank note. Pull in the global template by searching pain comp then choose Comprehensive Pain Notewriter/APSO. Reminder: Be sure to always click accept! 8

9 2. HPI: Click HPI and type pain or pain by location OR use your own personal dot phrase. 3. Supplement your note with additional details or delete this section. 9

10 4. ROS: On your own do whatever works for you. 5. Scroll through the assessments to find the physical exam documentation space. 6. Physical Exam: On your own do whatever works for you. 7. Click Plan in the chunky buttons to get to your problem list. 8. Search Chronic Pain ICD: G

11 9. You now have Chronic Pain Syndrome in your Problem List 10. Expand Chronic Pain Syndrome and click on Create Overview 11. Copy and Paste HPI into Overview section 11

12 12. Click Create Current Assessment & Plan Note 13. Type.Chronic into the note and choose Chronic Pain A&P 14. Pick and Click through the ORADER 12

13 15. Use the dropdown menu to describe the overall approach to Opioids. 16. Use the wildcard to add to patient s treatment plan. Repeat for other items. You can also pick and click using the wildcard. NOTE: You can add both long acting and/or short acting opioids to the patient s medication plan. 17. Click Opioid Medication plan. Add long acting and/or short acting opioid to their medication plan. 13

14 18. Add the next comprehensive visit OR delete this section. 19. The Assessment and Plan are in the note template. 20. Select Problem list A/P notes documented today along with the visit dx. 21. Remember: If you use problem based charting you can copy the previous problem note and amend it in the new encounter! Note: You can also write document in the Assessment and Plan section but in the log run problem based charting is the best option. 14

15 Follow Up Visits 1. For a follow up visit open a blank note and search pain follow up. Click on Pain Follow Up Notewriter/APSO 2. Choose follow up visit and copy the previous progress note. 3. Click the note you would like to copy then complete the remainder of the note the same way as the comprehensive note. 15

16 Creating and Filing the Opioid Partnership Agreement 1. Go to letters and search for PC Opioid Medication Partnership Agreement to find the Opioid contract. 2. Edit the contract to add the patient s refill dates. 3. Create a new flag to notify staff there is a pain contract. 4. Label it: Pain Management Plan 16