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/clinical/cckm-tools/content/order-sets/inpatient/pain-management/name-111186-en.cckm

201612362

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Pain Management

Chronic Pain Management [3195]

Chronic Pain Management [3195] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Pain Management


SmartSet: CHRONIC PAIN MANAGEMENT (ID:3195)
General Information
Display name: Chronic Pain/Opiate Management
Type: General
Merge priority: 0
Version comment:
Content source:
Synonyms: 1. UDS
2. Pain Management Profile
3. Urine Drug Screen
4. Chronic Opioid
5. Opiate Management
SmartSet notes:
Description:
Web
information:
Title URL
1. UW
Health Clinical Policy: Opiate Management
recommends the following for patients with non-cancer chronic pain being
treated with chronic opioids:

2.    Urine Drug Screening with the Pain Management Profile once a year
3.      •To exclude a patient from this protocol, complete the href="epicrelact:MR_VISITNAVIGATOR,RunParams:STARTUPSECTION=UWOP_SEC_MR_WI_PDMP_FLOWSHEET">Opiate
Management Form
.
4.      •To see a list of your patients on chronic opiates, go to My
Reports
.
5. .
6.    Maintain an updated Care Plan in the Problem List
7.      1. Place the "Chronic Pain" diagnosis on the Problem List.
8.      2. Place dotphrase, ".ChronicPainOverviewNote", into the Overview Note of the "Chronic Pain"
diagnosis.
9. .
10.    Review Controlled Medication Treatment Agreement and Wisconsin Prescription Drug Monitoring Program
once a year.
11.      •Controlled Medication Treatment Agreement
12.      •Record the dates of review in the href="epicrelact:MR_VISITNAVIGATOR,RunParams:STARTUPSECTION=UWOP_SEC_MR_WI_PDMP_FLOWSHEET">
Opiate Management Form
.
13. .
14.    Use the following Chronic Pain Assessment Tools once a year.
15.      •Brief Pain Inventory
16.      •Physical Functional Ability Questionnaire (FAQ5)
17.      •Patient Health Questionnaire-9 (PHQ-9)
18.      •Scores can be entered in the href="epicrelact:MR_VISITNAVIGATOR,RunParams:STARTUPSECTION=UWOP_SEC_MR_BRIEF_PAIN_FLOWSHEET">
Chronic Pain Activity
and be viewed in Synopsis.
Questionnaire:
Configuration
Documentation
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Printed by STRAKA, KEVIN F [KFS1] at 12/22/2016 10:49:30 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Documentation
Chronic Pain - Brief (.ChronicPainNoteBrief) UWOP CHRONIC PAIN NOTE BRIEF
Chronic Pain - Full (.ChronicPainNoteFull) UWOP CHRONIC PAIN NOTE FULL
D.I.R.E. Score: Patient Selection for Chronic Narcotic
Analgesia
DIRESCOREFORM
Laboratory
Lab Orders
Pain Management Profile Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Cannabanoids Screen Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Lab Orders
Pain Management Profile Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Cannabanoids Screen Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Lab Orders
Pain Management Profile Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Cannabanoids Screen Status: Standing, Expires:T+122 MANUAL,Count:1, Normal, Routine
Consult
Consults
Consult to Pain Clinic - INSIDE UW Health What barrier to medical care would you like the specialist to address?
(REQUIRED):
Are you willing to take over prescribing of opioid medications if started
and optimized by the Pain Clinic?
Are you willing to take over prescribing of non-opioid medications if
started in the Pain Clinic?
Do you have any concerns about this patient in general or concerns about
using pain medications for this patient? If YES, please describe:
Are there any opioid medications that you are uncomfortable prescribing
from this list? (please select if unwilling to prescribe the medication):
Any other comments or questions regarding this patient's care that may
assist us in caring for your patient?
Consult to Pain Clinic - OUTSIDE UW Health What barrier to medical care would you like the specialist to address?
(REQUIRED):
Are you willing to take over prescribing of opioid medications if started
and optimized by the Pain Clinic?
Are you willing to take over prescribing of non-opioid medications if
started in the Pain Clinic?
Do you have any concerns about this patient in general or concerns about
using pain medications for this patient? If YES, please describe:
Are there any opioid medications that you are uncomfortable prescribing
from this list? (please select if unwilling to prescribe the medication):
Any other comments or questions regarding this patient's care that may
assist us in caring for your patient?
Consult to Pain Psychology - INSIDE UW Health Request Type:
Reason for this request:
Consult to Pain Psychology - OUTSIDE UW Health Request Type:
Reason for this request:
Patient Instructions
Patient Instructions
Opioid Medicine for Chronic Pain: Health Facts for You OPIOID MEDICINE FOR CHRONIC PAIN - HFFY #7716 (PI)
Developing a Pain Management Plan: After Your Visit PAIN: MANAGEMENT PLAN (ENGLISH)
Learning About a Pain Diary: After Your Visit PAIN DIARY: GENERAL INFO (ENGLISH)
Diagnosis
Diagnosis
Page 2 of 3
Printed by STRAKA, KEVIN F [KFS1] at 12/22/2016 10:49:30 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org

Chronic pain Other chronic pain
Opioid use agreement exists Diagnosis
Pain medication agreement Encounter for long-term (current) use of other medications
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END OF SMARTSET
Other Chief Complaint
Criteria
Suggestions: LOOKUP LOCATOR-CHRONIC OPIOID-RFV[2882]
LOOKUP LOCATOR-CHRONIC OPIOID-IS ON REGISTRY[2883]
Filter: RESTRICTION LOCATOR-ALL SITES[27]
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Page 3 of 3
Printed by STRAKA, KEVIN F [KFS1] at 12/22/2016 10:49:30 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 12/2016CCKM@uwhealth.org