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

*Borrowed from CSAT Workshop*Borrowed from CSAT Workshop on Risk Management-2005 on Risk Management-2005  Document  Communicate risks  Review and correct  Consider what’s “reasonable” and “foreseeable”  Assess for impairment  A ttend to RED flags

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

Patient is unknown and history may be unreliable Patient is unknown and history may be unreliable Patients’ responses to methadone may be variable Patients’ responses to methadone may be variable Patient may not adhere to treatment recommendations Patient may not adhere to treatment recommendations

Trends show impairment as an increasingly likely factor in more claims filed against OTPs

High Risk for Impairment During the induction process Drug-Drug interactions with methadone ▫Benzodiazepines ▫Alcohol ▫Cocaine ▫Other sedative-hypnotic medications ▫Muscle relaxants

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, document