NCHN

How to Do a Visit 

First, pump yourself up and get ready to open a million windows on your laptop. 

Find a HIPAA compliant space :) 

Teams:   FMC MAAT/ NCHN 

1) Open Provider Schedule and log your shift type on the drop-down menu

2) Open Patient Schedule, make sure you're on the correct day

3) Look for a patient that’s checked in (CI), click on “CI” box, type your initials to claim them, if no answer add "-callx1 (time)". Patients are typically called twice about 10 minutes apart.

4) Consider any special info before calling: Outstanding UDOAS? Preop planning? Pregnancy? Hep C (+)? 

Epic:   FMC Fam Med OP -> FMC MOUD Clinic

1) Start note

2) Check PDMP - any gaps in tx, what length of scripts, any other controlled substances prescribed (for example, did they get opioids from the ED?) - mark as reviewed!

3) Quickly peep the Problem List (OUD) to see the last update, brief substance hx, infectious labs, complicating social factors, etc.  

4) Call Patient in Doximity, use 970-484-4469 (don’t use FMC phone#)

- "How are you taking the medicine?" - name, dose, and fx

              (standard upper limit is 8 mg TID)

- Try to collect a fun fact for our weekly fun fact competition

- Ask patient how they are doing: relapses, gaps, withdrawal sx, cravings, satisfaction

- Make sure they have Narcan (unexpired!) at home

- What pharmacy? Don't assume it's the same as last time. 

5) Send script (or pend it for a DEA-wielding doc to sign) 

6) Update the Problem List, be sure to write length of script given and follow up plan

7) Code visit - charge capture - Telephone Visit vs Est 3  

9) Sign encounter - you'll be prompted to add chief complaint and change provider to you

11) Go back to TEAMS Patient Schedule, COPY & PASTE the patient information to the next visit list (1wk, 2wk, 1mo) 

12) Rinse, repeat

Follow up timing: 

• usually guided by most recent UDAOS (i.e. 4w if you're refilling x28d)

• if pt is unstable, follow up sooner! 

• if pt requests to follow up sooner, great! 

Dot phrases

.fmcNCHNintake 

.fmcNCHNtelefollowup

.fmcNCHNfollowup - in person routine follow up 

.fmcNCHNprob - to start a problem "opioid use disorder, severe" 

.fmcNCHNudoas - for UA policy in your problem 

Order sets 

• fmcFAV - Pain/MOUD Suboxone induction (standard and micro)

• fmcFAV - Pain/MOUD comfort meds panel

• fmcFAV - Pain/MOUD ID screening panel - be sure Hep C & HIV screens are ordered for all folks!

• fmcFAV - Pain/MOUD narcan 

UA Policy

Buprenorphine is a controlled substance, it can be diverted, and it can be lifesaving! 

Our responsibility is to document adherence & troubleshoot if there are concerns. 

We don't tox test for other substances.

The day the test is completed is “0”:  

- 0-3 months: eligible for 1 month rx  

- 3-4 months: eligible for 2 week rx R1  

- 4-5 months: eligible for 1 week rx R3  

- 5 months (appt directly following): 1 week  

At 5 months w/o UA, prescribing may be discontinued based on provider discretion, and visits should be weekly. 

IF A TEST IS NEG:  pt is rq'd to complete a confirmatory test (bupe quant) at a UCH lab for more thorough analysis w/in 1-2w of neg test.  

NCHN UA times: 

Mon, Tues, Thurs, Fri: 9 am to 445 pm | Weds: 11 am to 645 pm 

UCHealth lab UA order 

"Buprenorphine Screen Urine w/reflex to quant" - standing option for every patient