Implementing a standardized EHR-integrated controlled substance agreement in outpatient psychiatry

Problem: There is a high likelihood of abuse, misuse, dependency, diversion, and other adverse events among patients who were prescribed controlled substances. In the psychiatric setting, controlled substances include benzodiazepines, stimulants, and sedative-hypnotics. In most psychiatric practices, communication between patients and providers about prescribing expectations and refill policies remained inconsistent and undocumented. This lack of documentation compromised legality and, more importantly, safety. Purpose: The role of the Doctor of Nursing Practice (DNP) Evidence-Based Practice/Quality Improvement (EBP/QI) project was to implement and evaluate a standardized, electronic health record (EHR)-integrated controlled substance agreement (CSA). This project aimed to improve provider documentation, enhance patient education, and promote safer prescribing in the outpatient psychiatric clinic. Methods: This project took place at Start My Wellness in Ferndale, Michigan. Previously, providers relied solely on verbal counseling without standardized documentation, such as a CSA, or used their own templates obtained from other sources. The Plan-Do-Study-Act (PDSA) framework guided implementation and evaluation. First, a standardized CSA was integrated into the EHR and piloted with nurse practitioner (NP) champions. Later, it was implemented across all providers. Results: At baseline in November, 46.2% of patients signed the CSA (NP champion). During the initial implementation in December, with a clinic-wide rollout, 42.5% of patients signed the CSA. During sustained monitoring in January, 45.7% of patients signed the CSA. The overall completion rate was 43.8%. However, results also showed that provider participation in tracking was 37.5%. Challenges such as time constraints, other clinical duties, and the additional step of documenting CSA completion in a separate, external document contributed to this number. The post-implementation survey revealed that NPs reported that the CSA tool improved their documentation practices, enhanced patient education about controlled substances, and increased their satisfaction with prescribing practices. These improvements enhanced the overall quality of care and safety for patients receiving controlled substances. Conclusions: The standardized, EHR-integrated CSA tool led to considerable improvements in documentation, patient education, and provider satisfaction. At the same time, barriers were identified, such as increased workflow steps and unclear responsibility for follow-up tracking. This severely limited full adoption and sustainability among participating providers. These findings highlighted the positive impact of the CSA tool but also showed the need for an improved EHR integration with automated support within the system to ensure compliance and maintain practice changes.

Authors dc:creator

• Rizvi, Siddiqa
• Adkins, Marie

Contributors dc:contributor

• Jones-Brown, Natalie

• Ambulatory medical care
• Medical records--Data processing
• Patient compliance
• Psychotherapy patients--Drug use

Statement dc:rights

• In Copyright

Language dc:language

English

Identifier

dnp:102
oclc:1601633994
local:R_7zROlUgXzRjN5D6

OAI identifier oai:identifier

oai:d.lib.msu.edu:dnp_102