Melrose Pain Solutions® Method and Algorithm: Managing Pain in Opioid Dependent Patients

The algorithm-based system of claim wherein each phase (initial Encounter, Admission, Inpatient Care, and Discharge) have tied to them time, location and staff components that better utilizes limited resources, further enhances the systems' goals of timely and adequate pain control, and facilitates overall better healthcare to patients as follows:

• Initial Encounter
• a) PCA placement and use initiates faster pain control with less need for nursing intervention
• b) Buprenorphine and/or buprenorphine/naloxone delivers pain control for longer periods with less need for nurse intervention
• c) Greater communication, a concerted group approach, and single system, utilization between and among healthcare providers provides less redundancy and duplicative action in the Melrose Pain Solution® system
• Admission
• a) Time location and staff component carries with it the benefit of knowing which steps were taken and at what time In an effort to optimize timely pain control (e.g. within the optimal time of 30 minutes to 6 hours)
• Inpatient Care
• a) Time location and staff components lead to optimum pain control, increased patient compliance, higher staff satisfaction rates, and higher HCAP scores,
• Discharge
• a) With a temporal emphasis, the Melrose Pain Solution® system seeks to
• i. provide prescription(s) well in advance of patient leaving the facility
• ii. recommends filling prescription on-site when possible (beds-to-meds)
• iii. deliver substance abuse referrals as appropriate

A method for managing and tracking potential and active opioid-dependent patient data for the maintenance and management of treatment of an opioid-utilizing or opioid-dependent pain treatment patient, said method comprising:

• establishing clinical criteria and protocol for the assessment, evaluation and placement of patients into categories and sub-categories based on patient presentation, patient history, diagnostic questioning and tests, and a differential diagnosis by a trained healthcare professional upon the initial encounter, in emergency department or urgent care settings, and determining (a) level of pain control, (b) level of opioid use, (c) level of opioid dependency, and (d) clinical stability;
• placing patient into one of two categories (a) outpatient or (b) inpatient (hospital admitted);
• treating outpatient individuals with (a) 3 to 7-day supply of opioids with pain physician referral for continued care or (2), after verifying opioid abuse through a state controlled substances monitoring program (e.g. PDMP—Prescription Drug Monitoring Program) and Integration of additional considerations as to opioid usage, dispensing non-opioid medications or (3) dispensing buprenorphine and/or buprenorphine/naloxone with referral to a detoxification center or dependency drug authorized dispenser;
• treating inpatient (hospitalized) patients, through additional testing, varying data points determinations, and treatment decisions, with (1) continued patient controlled analgesia pump, oral or transdermal opioid with or without a non-opioid analgesic, (2) acute buprenorphine and/or buprenorphine/naloxone with a transition to a maintenance buprenorphine and/or buprenorphine/naloxone, or (3) short acting opioids with a transition to maintenance buprenorphine and/or buprenorphine/naloxone;
• discharging patients after observation and subsequent stabilization with an establishment of risk/likelihood of reoccurrence and outpatient treatment plan (taking into consideration possible suboptimal pain therapy regimen, ineffective therapies, inability to take certain formulations, long-acting versus short-acting opioids, and history of substance abuse) up to and including modification of current drug treatment and possible inclusion of buprenorphine and/or buprenorphine/naloxone.