Project Summary:

There are over 100 internal medicine residents who see patients in the Barnes Jewish Hospital Primary Care Clinic. Due to the necessary difficulty of their schedules they often need to cross-cover each-other. This raises some unique difficulties as opiates require monthly refills and as such are often prescribed by residents who do not have a long-term relationship with the patient.

We sought to improve adherence to safe prescribing guidelines by creating a report to calculate the number of milligrams of morphine equivalently (MMEs) each patient was on, last urine drug screen, last pain contract and whether they have been prescribed Narcan or have a benzodiazepine co-prescribed.

Relevant Skills:

• Clinical Medicine
• Quality Improvement
• SQL
• Change Management

Implementation:

Working closely with clinic leadership and our reporting team we devised a report as described above. We improved the Epic calculation of MMEs by leveraging the fact that our clinical always prescribed a 30 day supply of opioids for chronic pain patients and therefore we did not have to rely on the directions for each prescription to determine MMEs.

The report was issued for each team of residents for their review weekly with their continuity attending. The full report was also shared with all residents for their review.