A6-b - Safer Opioid Prescribing through a Clinic-wide Urine Drug Testing System – the HARMS Program

6. Enabling high -performing primary health care

  • Date: Thursday, September 19, 2019
  • Concurrent Session A
  • Time: 2:30pm-3:15pm
  • Room: Pier 9
  • Style: Presentation (information provided to audience, with opportunity for audience to ask question)
  • Focus: Practical (e.g. Presentation on how to implement programs and/or practices in the team environment)
  • Target Audience: Leadership (ED, clinical lead, board chair, board member, etc.), Clinical providers, Administrative staff, Representatives of stakeholder/partner organizations

Learning Objectives

1) Recognize how urine drug testing (UDT) results can be important in guiding safer opioid prescribing for chronic pain  
2) Examine the barriers that have previously prevented effective implementation of UDT in clinical medicine 
3) Explore the HARMS innovations that address these barriers
4) Implement a UDT system (such as the HARMS Program) in the primary care setting

Summary/Abstract

Guidelines for opioid prescribing in chronic non-cancer pain (CNCP) recommend routine urine drug testing (UDT) to monitor safety. When used properly, UDT can inform clinicians about the risk/benefit balance of opioids and influence how they are prescribed and further monitored. Unfortunately, despite these potential benefits, there are significant logistical barriers that have prevented effective implementation of UDT in clinical medicine.  The Marathon Family Health Team (MFHT) designed, implemented, studied and refined a clinic-wide system that applies UDT to all patients prescribed opioids for CNCP. The system would become known as the HARMS Program (High-yield Approach to Risk Mitigation and Safety), and is the first system built to support routine UDT in primary care. Given that it was created by frontline clinicians in a rural, resource-limited setting, it has a high potential for scalability to other primary care sites.  The presenter will summarize five years of lessons learned as he covers the practical elements of implementing a UDT system at your clinic. The key innovations built into the HARMS program will be discussed: 1) Systems Protocols: nearly the entire program is run by clinical administration under the guidance of protocols. 2) Automation: novel EMR-integrated software that uses a tablet PC to collect all of the necessary information for a UDT and then automatically interprets those UDT results within the limitations of the test. 3) Clinical Guidance: the HARMS Risk Ladder guides not only how frequently to conduct UDT for a given risk level, but also how to act on any result.
 

Presenter

  • Ryan Patchett-Marble, MD, CCFP (AM), Marathon Family Health Team, Northern Ontario School of Medicine

Authors/Contributors