Risk Mitigation
Risk mitigation can be defined as the process of identifying potential risks, assessing their impact, and then implementing strategies to minimize or eliminate the likelihood of such risks occurring, effectively decreasing the potential negative consequences of a threat or hazard (National Institutes of Health, 2024). It also involves taking proactive steps to manage risks and limit their impact on an organization and/or project. Once risks are identified, then their potential impact and likelihood of occurrence need to be evaluated (World Health Organization, 2024). Based upon risk assessment, appropriate strategies are then developed to decrease the risk’s probability or impact on and organization and/or project. The chosen mitigation strategies are then implemented; ongoing monitoring is crucial to ensure their effectiveness (National Institutes of Health, 2024). Examples of risk mitigation strategies include diversification, insurance, contingency planning, and training/education. Diversification includes the spreading of investments across different asset classes to decrease the impact of market fluctuations, insurance includes purchasing insurance policies to transfer the financial burden of certain risks to an insurance company, contingency planning includes developing backup plans to address potential disruptions or emergencies, and training/education includes providing employees with training to assist them in identifying and avoiding potential risks (Shaffer, 2022).
Risk mitigation when prescribing controlled substances involves actively taking steps to minimize the potential for abuse, diversion, and adverse events by thoroughly assessing the patient, utilizing prescription drug monitoring programs (PDMPs), educating patients about the risks, closely monitoring treatment, and considering alternative therapies when appropriate, all while documenting the decision-making process carefully; essentially focusing on “collecting information,” “communicating with the patient,” and “carefully documenting” the treatment plan must be included (National Institutes of Health, 2024). Key strategies for risk mitigation include a thorough patient assessment, low-risk prescription practices, effective communication, and documentation. Regarding patient assessment, the clinician must discuss the risks and benefits of controlled medications with the patient, ensuring informed consent (Shaffer, 2022). High-dose opioids must be avoided unless clinically indicated; the lowest, most effective dose must be prescribed for the shortest duration. The patient’s response to medications should be monitored and doses should be adjusted accordingly (Stahl, 2021). The rationale for prescribing controlled substances, including the patient’s pain assessment, discussion of risks and benefits, and treatment plan should all be thoroughly documented; concerns about potential abuse and/or diversion must also be included (National Institutes of Health, 2024).
Questions to Ask Regarding Risk Mitigation of Controlled Substances
When mitigating risks associated with controlled substances, key questions to ask include: how are controlled substances stored and secured?, who has access to controlled substances?, are there procedures for regular inventory checks and reporting discrepancies?, are staff trained on proper handling and documentation of controlled substances?, are there safeguards against diversion, theft, and misuse?, what monitoring systems are in place to identify potential issues?, are there processes for reporting suspicious activity?, and how are expired or damaged controlled substances disposed of? (Shaffer, 2022). The storage of controlled substances needs to include where they are stored, what type of locking mechanism is used, whether there are security cameras monitoring storage areas, and if controlled substances are stored away from other medications. Questions regarding access to controlled substances should include who is authorized to access them, what procedures are in place for verifying identity prior to dispensing them, and if there are any limits on the quantity of controlled substances that can be dispensed at one time. Inventory management questions should include how often inventory of controlled substances are conducted, who is responsible for conducting the inventory, and what procedures are in place for reporting discrepancies. Questions regarding disposal procedures should include what process is used to dispose of expired and/or damaged controlled substances, and what the procedure is for witnessing the disposal of controlled substances (Bryson, 2023).
Helpful Resources to Use When Studying Risk Mitigation
A beneficial resource that I currently use in my role as a family nurse practitioner (FNP) and that I also plan on using in my future role as a psychiatric mental health nurse practitioner (PMHNP) is the Ohio Automated Reporting Rx System (OARRS). OARRS is a tool that assists clinicians throughout the state of Ohio in tracking the dispensing and personal furnishing of controlled prescription medications to patients. Ohio law allows a pharmacist and/or prescriber to request a patient prescription history report solely for the purpose of treatment (Ohio Automated Rx Reporting System, 2024). Another valuable resource that I currently use in practice is the Prescription Drug Monitoring Program (PDMP). PDMPs are state-ran programs that are used to identify patients at risk for overdose and/or in need of treatment for substance use disorder (SUD), used to improve opioid prescribing/inform clinical practice, used to decrease the diversion of medication by sending reports to law enforcement, regulatory, or licensing agencies (Bryson, 2023). Regardless of the state in which the clinician practices, he or she should use the “6 Rs” when managing opioids: rotation, reduction, replacement, reversal, referral, restriction. Rotation includes switching from one opioid to another as a way of facilitating dose reduction, reduction includes tapering opioid doses over weeks to prevent withdrawal and/or adverse effects, replacement includes choosing a different medication (not necessarily an opioid) to control symptoms of pain, reversal includes the use of Narcan in the event of respiratory distress and/or unresponsiveness, referral includes encouraging the patient to see a psychologist and/or physiotherapist, and restriction includes the frequency of face-to-face encounters between the clinician and patient in addition to prescribing smaller, less frequent amounts, thus requiring the patient to pick up medications at the pharmacy (Shaffer, 2022).
References
Bryson, M. (2023). Risk-reducing strategies to overcome opioid abuse. Journal of Nursing
Care Quality, 479(8), 88-97. doi: 7573960789/356-1
National Institutes of Health. (2024). Handling and safeguarding of controlled substances.
Retrieved from: Links to an external site.
Ohio Automated Rx Reporting System. (2024). Ohio automated rx reporting system.
Retrieved from: Links to an external site.
Shaffer, E. (2022). Understanding substance use disorder. Journal of Nursing Research,
180(5), 1001-1004. doi: 30672667/833-1
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and
practical applications (5th ed.). Cambridge University Press.
World Health Organization. (2024). Access to medicines and health products. Retrieved
from:
Classmate #2:
What is Risk mitigation? What questions do you ask?
The Center for Disease Control and Prevention (CDC), released guidelines in 2016 for prescribing opioids and risk mitigation strategies (REM) to aid in the prevention, misuse, opioid use disorder and overdose (Tata et al., 2023). The eleven recommendations include the instruction of providers to utilize non-pharmacologic and non-opioid therapy for patients with chronic pain and strategic plans to implement when initiating opioid therapy with a goal to mitigate the risk of overuse and abuse that can lead to adverse events (Tata et al., 2023). The risk management strategy recommendations include the management schedule of dosing, patient education, screening protocols for at risk patients, monitoring and reviewing the prescription drug monitoring program (PDMP) and routine follow up for patients with an opioid prescription (Tata et al., 2023).
The Prescription Drug Monitoring Program (PDMP), was executed to mitigate prescription misuse, diversion and utilized to monitor and examine prescription dispensing information for controlled substances (D’Souza et al., 2023). The PDMP database contains information across the state that track prescriptions of controlled substances in a specific state (D’Souza et al., 2023). The PDMP is implemented by health providers and authorities to retrieve up to date information on prescribing and tracks the pattern of patient behaviors as it relates to receiving multiple controlled-substances from a variety of providers (D’Souza et al., 2023).
What resources have you found that help you study this subject?
The South college library has a variety of resources on the topic of risk mitigation and specific specialty areas common to the treatment of opioids such as pain clinics and cancer treatment clinics. I found the National Library of Medicine to be a great resource for current FDA and CDC recommendations for the PDMP. The American Psychiatric Association is another resource that helps understand the updated policy’s on medication changes. The APA, incorporates a policy and practice insight series for timely updates and current events.
References:
D’Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. 2023 Jun 20. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
McGowan J, Wojahn A, Nicolini JR. Risk Management Event Evaluation and Responsibilities. 2023 Aug 23. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: Links to an external site.
Tata, V., Al Saadi, R., Cho, S. K., Varisco, T. J., Wanat, M., & Thornton, J. D. (2023). Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis. BMC Health Services Research, 23(1), 1–13.
Zhang P, Patel P, Winston NR. Federal Medication Development Regulation. 2024 Feb 12. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
