title: Risk Stratification for Opioid Misuse in Children, Adolescents, and Young Adults: A Quality Improvement Project.
abstract: The Pediatric Palliative and Comfort Care Team (PACT) at Cincinnati Children's Hospital Medical Center (CCHMC) provides opioids to a large population of patients in the ambulatory setting. Before this project, PACT had no reliable system to risk stratify patients for opioid misuse.
  
  
  
  The global aim was safe opioid prescribing by the palliative care team. The specific, measurable, achievable, realistic, and timely aim was as follows: "In patients who present for follow up with PACT, we will use the "opioid bundle" to increase risk stratification for opioid misuse from 0% to 90% over 5 months." The opioid bundle includes a urine drug screen, Ohio Automated Rx Reporting System report, pill count, and screening history for drug abuse and mental health disorders. The setting was multiple CCHMC ambulatory clinics. Participants included all PACT members.
  
  
  
  Since implementing the new system, we have increased risk stratification for opioid misuse among outpatients from 0% to >90%. Results have been sustained for 12 months. Key processes have become reliable: obtaining informed consent and controlled substance agreements for all new patients and obtaining the opioid bundle to enable risk stratification in a consistent and timely fashion. A total of 34% of patients have been stratified as high risk, and an additional 27% have been stratified as moderate risk.
  
  
  
  A system to ensure safe opioid prescribing practices to all patients is critical for providers. Identifying key processes and executing them reliably has enabled the palliative care team at CCHMC to risk stratify >90% of patients receiving opioids in the ambulatory setting for opioid misuse.
authors.affiliation: The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology, rachel.thienprayoon@cchmc.org.|Cancer and Blood Diseases Institute, Department of Pediatrics, and.
authors.forename: Rachel
authors.initials: R
authors.lastname: Thienprayoon
authors.affiliation: The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology.
authors.forename: Kelly
authors.initials: K
authors.lastname: Porter
authors.affiliation: The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology.
authors.forename: Michelle
authors.initials: M
authors.lastname: Tate
authors.affiliation: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Marshall
authors.initials: M
authors.lastname: Ashby
authors.affiliation: The Pediatric Palliative and Comfort Care Team, Division of Pain, Department of Anesthesiology.
authors.forename: Mark
authors.initials: M
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use* / Q000633:toxicity*; D002648:Child; D005260:Female; D017051:Hospice Care; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009820:Ohio; D010166:Palliative Care; D064226:Prescription Drug Diversion / Q000517:prevention & control / Q000706:statistics & numerical data; D063487:Prescription Drug Misuse / Q000517:prevention & control* / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration*; D018570:Risk Assessment / Q000458:organization & administration*; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid