This resource library supports clinics in implementing the Six Building Blocks program for improving opioid management in primary care. You’ll also find links to these resources in the implementation guides.
Implementation Guides
These guides are designed for clinics that want to independently implement effective, guideline-driven care for their patients with chronic pain who are using opioid therapy.
While anyone can use these materials, they are specifically written for quality improvement personnel and project managers to use in guiding improvement and care teams through the Six Building Blocks implementation process.
- Introduction
- Self-Assessment
- Stage 1: Prepare and Launch
- Stage 2: Design and Implement
- Stage 3: Monitor and Sustain
Resources by Topic
Leadership and Consensus
Leadership
- Building an Opioid Improvement Team: Information about who should be on an opioid improvement team to lead opioid management quality improvements.
- Chronic Pain Management Support Teams: Questions to consider when developing a chronic pain management support team.
Building Consensus
- Six Building Blocks Self-Assessment: Tool for measuring status in the Six Building Blocks. Used by the opioid improvement team to track progress over time.
- Elevator Speech on Six Building Blocks: Tips for how to talk with others in your organization about why you are improving opioid management through the Six Building Blocks.
- Strategies for Supporting and Motivating Providers Who Are Slow to Adopt Policies: Specific strategies for encouraging providers to adopt the practices in new or revised policies for chronic opioid management.
- Levers of Motivation and Six Building Blocks: Methods for motivating providers and staff participating in opioid management improvement work.
Clinical Education for Staff and Clinicians
- Clinical Education Opportunities on Opioids and Chronic Pain: List of clinical education opportunities on opioids and chronic pain by topic.
Policy, Patient Agreement and Workflow
Policy Revision
- Model Opioid Prescribing Policy: Example opioid prescribing policy to use during the policy revision process. Developed using CDC guidelines and Washington state opioid prescribing rules.
- Opioid Policies Checklist: Use when reviewing your policy to ensure it aligns with evidence-based guidelines.
Workflow Revision
- New or Chronic Pain Appointment Workflow: Example workflow for new or chronic pain appointments.
- Remote Urine Drug Testing: Frequently asked questions about conducting urine drug testing remotely and an example remote UDT workflow.
- Opioid Refill Workflow: Example workflow for processing opioid refill requests.
- Opioid List Manager Workflow: Example workflow for tracking and monitoring patients on long-term opioid therapy.
Rollout and Training
- Rollout and Training: Suggestions for how to roll out and train on new and revised policies, agreements, workflows and EHR templates.
Tracking and Monitoring Patient Care
Identifying Patients on Long-Term Opioid Therapy
- Approaches to Identifying Patients on Long-Term Opioid Therapy: Approaches to try when first attempting to identify patients on long-term opioid therapy.
Tracking and Monitoring Patient Care
- Purposes of Tracking and Monitoring: Key uses of data in tracking and monitoring patients on long-term opioid therapy to use when planning your approach.
- Developing a Tracking and Monitoring Dashboard: Tips for developing a dashboard of key measures for patients on long-term opioid therapy.
- Data to Consider Tracking: Variables to consider tracking and monitoring for care planning and measuring success.
- Tracking and Monitoring Example Spreadsheet: Excel spreadsheet clinics can adapt to track and monitor key measures overall and by provider if they are unable to easily pull reports from their EMR.
Calculating Morphine Equivalency
Planned, Patient-Centered Visits
Patient Education
- Education Resources for Patients With Chronic Pain: List of patient education materials relevant to patients with chronic pain, including resources about opioids, benzodiazepines, chronic pain, overdose, stigma and pain self-management.
- Patient Letter: Example letter introducing patients to the clinic’s new approach to caring for patients on long-term opioid therapy.
- Chronic Pain Care Plan: Tailored set of written steps and key information that a provider and patient agree will be used to manage the patient’s pain.
Tapering
- Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics: Important issues to consider when changing a patient’s chronic pain therapy.
Empathic Communication for Difficult Conversations
- Safer Management of Opioids for Chronic Pain: Principles and Language Suggestions for Talking With Patients: Key principles and specific scripts to help providers discuss opioid risks, safety monitoring or changes in treatment plan with patients.
- Staff Guidance on Difficult Conversations: Conversation approaches and scripts for clinical and administrative staff who interact with patients on long-term opioid therapy.
- Guide to Difficult Conversations About Opioids for Chronic Pain: Brief video example of how to talk with a patient about opioid tapering.
- Empathic Communication Resources: List of empathic communication and motivational interviewing resources.
- Stigma and Chronic Pain: Overview of the relationship between chronic pain and stigma as well as strategies for addressing stigma in the primary care setting.
Non-Opioid Treatments
- Complementary and Alternative Approaches to Chronic Pain: Summary of existing evidence for noninvasive nonpharmacological treatments and complementary health approaches for chronic pain conditions.
- Chronic Pain Self-Management Resources: List of chronic pain self-management resources for providers, care coordinators and patients.
Planning for Visits
- Patients on Legacy Prescriptions: Strategies for caring for patients on long-term opioid therapy that you have inherited from another clinician.
- Risk Stratification and Opioid Prescribing: Guidance on assessing risk of adverse outcomes in patients on long-term opioid therapy and varying care according to risk level.
- Turn the Tide Pocket Guide for Prescribing Opioids for Chronic Pain: Quick reference for clinicians about opioid prescribing.
- Pain Tracker: Examples of assessments to use during visits about chronic pain.
- Suggested Opioid Management Assessment Schedule: Tools and timelines for opioid management assessments.
- Telemedicine and Chronic Pain Management: Approaches to using telemedicine to care for with patients with chronic pain on long-term opioid therapy.
- Social Determinants of Health and Pain Management: Overview of the connection between social determinants of health and pain management as well as resources to help plan patient visits.
For specific assessment tools, such as the Opioid Risk Tool, see the Suggested Opioid Management Assessment Schedule.
Caring for Patients with Complex Needs
Assessment and Treatment
- DSM-5 Criteria for Diagnosis of Opioid Use Disorder: Checklist of the criteria to diagnose OUD using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
- Developing a Buprenorphine Treatment Program for Opioid Use Disorder in Primary Care: Guidance for primary care organizations and providers on developing a buprenorphine treatment program for opioid use disorder.
- Preventing an Opioid Overdose: Tip card by the CDC on the signs of opioid overdose and what to do if you think someone is overdosing.
- Opioid Overdose: Trifold brochure from the Center for Opioid Safety Education on actions to take in an opioid overdose.
- Washington Standing Order to Dispense Naloxone: Information about the standing order intended to aid people experiencing opioid overdose by facilitating wide distribution of naloxone, including instructions for pharmacists and directions for using naloxone.
Mental/Behavioral Health
- Integrating Behavioral Health and Primary Care Playbook: AHRQ guide to integrating behavioral health in primary care and other ambulatory care settings to help improve health care delivery to achieve better patient health outcomes.
Stigma
- Harm Reduction: Reducing Stigma: Overview of stigma and approaches to reducing stigma toward patients with opioid use disorder. From Alberta Health Services.
- Guiding Principles for Addressing the Stigma on Opioid Addiction: Johns Hopkins blog post offering evidence-based guiding principles for activities intended to reduce the stigma surrounding opioid use disorder.
Measuring Success
Measuring Success
- Measuring Success Metrics: List of potential aims to use to measure success.
- Measuring Outcomes Survey: Tool for assessing measures at the start and end of practice transformation work.
- Prepare and Launch Milestone Checklist: Tool for tracking progress toward Prepare and Launch milestones.
- Design and Implement Milestone Checklist: Tool for tracking progress toward Design and Implement milestones.
- Do-It-Yourself Run Chart: Excel tool from the Safety Net Medical Home Initiative for tracking progress on measures, e.g., up-to-date patient agreements.
- Event Tally: Form for tracking a simple measure of interest over a couple weeks.