Healthcare Inspection – Review of Opioid Prescribing Practices, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin

OIG conducted an inspection in response to a February 2015 request from Congresswoman Gwen Moore to review prescribing practices related to controlled substances at the Clement J. Zablocki VA Medical Center (facility), Milwaukee, WI. We also received an allegation that a provider at the facility had questionable opioid prescribing practices. To review the overall opioid prescribing practices at the facility, we evaluated whether facility and Veterans Integrated Service Network (VISN) leadership complied with specific goals (2, 3, 7, 8, and 9) delineated in the Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) Update. We determined the facility met Goal 2 (the number of patients who had an annual urine drug screen increased by nearly twofold from fiscal year 2014 through the second quarter of fiscal year 2015); Goal 8 (complementary and alternative medicine modalities were available), and Goal 9 (a collaborative model to manage opioids and benzodiazepines prescribing had been established). We made recommendations related to Goals 3 and 7. We substantiated that a provider prescribed opioid medications for some patients in a manner that varied from clinical guidelines and other facility providers. We recommended that the Veterans Integrated Service Network Director convene an expert panel knowledgeable in the subspecialties of Pain Medicine and Addiction Medicine to review the subject provider’s opioid prescribing practices within the context of the patients whose treatment varied from guidelines and submit a report of findings to the Veterans Integrated Service Network and Facility Directors; ensure the monitoring of patients on Suboxone; and ensure the Pain Committee strengthens processes to improve communication with the facility to ensure information is relayed timely. We also recommended that the Facility Director ensure that providers access the Prescription Drug Monitoring Program database as required by facility policy and monitor compliance and that adequate resources are allocated for patient reviews for opioid therapy appropriateness.