Examining the Effects of Interventional Pain Management Staff Controlled Substance Agreement Education for Patients with Chronic Non-Cancer Intrathecal Drug Delivery Device Opioid Therapy: A Retrospective Review

Chelsey Hoffmann,1 Trina McDonald,1 Becky Gladis,1 Michael E Schatman,2,3 Thomas P Pittelkow1 1Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Rochester, Minnesota, USA; 2Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 3Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USACorrespondence: Chelsey Hoffmann, Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA, Email [email protected]: Intrathecal drug delivery systems (IDDS) are effective tools for the management of chronic non-cancer pain, cancer-associated pain, and spasticity. Given the overall risks of opioid medications, it is imperative that IDDS opioid-infusion patients receive education regarding the risks versus benefits of their intrathecal opioid medications and that controlled substance agreements (CSAs) are utilized to both educate patients and hold them accountable for keeping IDDS programming visits, refill appointments, or other IDDS maintenance appointments.Methods: A retrospective electronic medical record (EMR) review study was conducted at an interventional pain management practice, quantifying the number of non-cancer chronic pain IDDS opioid therapy patients with signed CSAs. An educational intervention was conducted to increase staff awareness regarding compliance with CSAs and the location of proper CSA documentation within the EMR. Follow-up EMR review and provider knowledge assessment surveys were deployed to assess the success of the intervention.Results: Staff knowledge of CSAs increased from 14.3% (3/21) to 45.5% (10/22) following CSA education while their ability to locate CSAs within the EMR also increased from 38.1% (8/21) to 40.9% (9/22). Post-education intervention, rates of CSA documentation improved from 4.5% to 74.5%. Lastly, there was a 39.5% reduction in rescheduled IDDS appointments within the patient population studied.Conclusion: The results of this study suggest potentially profound impacts that a simple education intervention can have on staff knowledge and compliance with CSA documentation for patients receiving IDDS opioid therapy for chronic non-cancer pain. Furthermore, implementation of CSAs for this patient population may be associated with a decrease in the number of missed, no-show, or rescheduled IDDS maintenance appointments, which have important patient safety implications. Further research is warranted to investigate the impact of CSA compliance on adverse patient outcomes and the potential cost-savings practices with required CSAs.Keywords: controlled substance agreements, intrathecal drug delivery device, opioid therapy