CTI SP Instructions for the Faculty

From Clinicaltools.com

more stuff goes here Contents

1. Project Overview
   1. Case Overview
   2. Case Focus
   3. Checklist Items
2. Instructions to Participants (Students or Learners)
3. Instructions to Standardized Patient Actors
4. Instructions to Evaluators

Contents 1 Project Overview 1.1 Case Overview 1.2 Case Focus 1.3 Checklist Items 2 Instructions to Evaluators

Project Overview

Overall Project Goal

To train health professional learners when and if it is appropriate to screen for drug abuse, specifically prescription opioids and other potentially addictive substances used to treat pain as well as other addictive substances the patient may use, and to evaluate the interpersonal interviewing techniques of learners.

Targeted Learners:

Clinicians who prescribe potentially addictive pain medications

Case Overview

This case focuses on the risk of opioid dependence in individuals with chronic pain. Learners will encounter a patient with chronic, consistent pain from an old injury who presents with minor flu symptoms. Learners will be tasked with screening a standardized patient, already on opioids, for opioid abuse, interpreting the screening results together with suggestive symptoms and determining if a brief assessment is needed. Conducting a brief assessment, elaborating on them if appropriate, and interpreting the symptoms of the standardized patient discerning pain symptoms from symptoms related to drug abuse or withdrawal. They will be tasked with deciding if the patient needs further assessment/treatment by a specialist according to the local resources available and the clinician's experience. The main learning objective of this case is to encourage learners to screen all patients for abnormal and/or possibly addictive addictive opioid use, to use further questions designed to determine the difference between proper and illicit use of pain medication, and to document screening and brief assessment results clearly. The standardized patient framework allows for a superior learning experience with this objective, as health professional learners are encouraged to use their interpersonal interviewing skills to arrive at an assessment that balances the pain relief needs of the standardized patient with the health care provider's responsibility to prevent possible dependence.

Case Focus

Interpreting signs of opioid dependence and screening results, investigative assessment technique, drug screening models, and mitigating current, chronic pain with safe usage of opioid pain relievers.

Major Purposes of Case

After meeting with the standardized patient (SP), the learner will:

1. Assess the patient's symptoms
2. Assess the patient's knowledge of the danger of opioid abuse
3. Develop a plan to treat the symptoms of the SP that accounts for the risk of opioid abuse

Case Specific Essential Knowledge, Skills and Behaviors to be Demonstrated:

1. Knowledge of opioid abuse risk behaviors
2. Usage of screening tools to determine patient's opioid dependence level
3. Sensitivity towards the patient's case
4. Pointed questioning that enables the learner to distinguish between pain management or drug abuse in the patient's case.

Primary Challenges Presented by the Patient's Behaviors

1. Long time pain medication use has blurred the difference between pain management and dependence
2. The patient is proud person who does not want to be on pain medication, but feels he must be to live a somewhat normal life
3. The patient has serious chronic pain that must be considered before continuing pain medication regiment or beginning a detoxification.

Expected Diagnosis and Problem List:

Significant risk for opioid dependence

Checklist Items

Risk Factor Assessment The learner:

• Identified the major opioid dependence risk factors in the patient (long time opiate use, inability to function without medication, physical signs, etc)
• Used at least two (2) substance abuse screening instruments in their assessment of the patient, including CAGE-AID, the Two-Item Conjoint Screening, the DAST-10, or others.
• Ordered appropriate follow up tests and/or referrals

Patient Care The learner:

• Presented a detailed assessment to the patient, that includes his/her opinion of the patient's state of health, the physician's concerns, and treatment options
• Dealt with the patient in a sensitive, non-judgmental way about their possible drug dependence
• Asked different types of questions in order establish a rapport with the patient and determine their level of drug use. This includes asking a mix of open-ended, assumptive, and targeted questions in a simple, matter-of-fact fashion while reassuring the patient that their answers are confidential

Instructions to Evaluators