Effective Risk Management Strategies in Outpatient Methadone Treatment: Clinical Guidelines and Liability Prevention Curriculum MODULE 3 The Relationship between Risk and Practice in the OTP
OTP Ideal Standard of Care From admission, each patient receives: • Individualized clinical care Ongoing Documented • Competent staff • Good clinical judgment OTP clinical practice standards Incorporating best- and evidence-based practices * Adapted from CSAT Workshop on Risk Management - 2005
OTP Core Liability Failure to: • *Borrowed from CSAT Workshop on Risk Management-2005 Ø Document Ø Communicate risks Ø Review and correct Ø Consider what’s “reasonable” and “foreseeable” Ø Assess for impairment Ø Attend to RED flags
RM Strategy: Informed Consent
Informed Consent for OTPs Patients should understand: ▫ Basic science of addiction ▫ Methadone treatment Benefits Risks Alternatives
The Right Thing to do: Phased Informed Consent
Consents: A Valuable RM Tool • Providing information via consents may increase and motivate patient involvement in treatment • Phased informed consent ▫ Helps share or “transfer” risk ▫ Provides patient buy-in ▫ Identify understanding and comprehension related to treatment
Added at Admission n and w nkno eliable u ent is be unr • Pati may y o nses t riable histor o s’ resp y be va t Patien one ma • ere to h d ot ad ations metha n t may ommend Patien nt rec • eatme tr
RM Strategy: Integrate Patient’s Family
Impairment-A Severe Exposure • Trends show impairment as an increasingly likely factor in more claims filed against OTPs DANGER Ahead
High Risk for Impairment • During the induction process • Drug-Drug interactions with methadone ▫ ▫ ▫ Benzodiazepines Alcohol Cocaine Other sedative-hypnotic medications Muscle relaxants
RM Strategy: Do Not Bury your Head in the Sand • Duty to take action • Duty to warn
In Summary • DON’T IGNORE • Duty to warn • Duty to make reasonable inquiry and assess • Obtain Phased Informed Consent • Document, document