A limited inspection of the Poplar Bluff VA's opioid drug management practices has found some procedures were not followed, but local officials say the results do not reflect changes made at the facility in the past 15 months.
The release of findings comes after John J. Pershing VA Medical Center has been under fire in recent months because of complaints made by pain management doctor Dale Klein, who has been critical of procedures regarding narcotics management.
The Department of Veterans Affairs says an inspection was conducted in January 2016 because of anonymous claims. The VA did not give specifics about the claims in a press release issued last week, but said they had to do with opioids. Opioids include prescription pain relievers such as hydrocodone, codeine and oxycodone.
The Office of Inspector General did not conduct a random sample, but reviewed 10 veterans selected by the complainant.
Of these, six did not have urine drug screens done as recommended. Five had not signed informed consents before beginning long-term drug therapy. Providers also prescribed the drugs without documenting risk through a risk stratification tool, according to the OIG.
The OIG has made recommendations to resolve these issues, and Pershing staff say they have complied.
Better communication with providers outside the VA system, was among these changes. These providers need timely notification of clinically significant changes that could impact the patient's prescription, the OIG said.
A pain management clinic pharmacy specialist is also supposed to assist providers with tapering patients off opioids.
More education is to be given to providers about the risks of opioids and a committee monitors the completion of informed consents.
More steps were to be put into place to ensure urine drug screenings were done and interpreted correctly. A committee regularly reviews the completion rates, according to the VA.
An audit process has been developed and the most recent results showed 4 out of 4 patients had completed the urine test, the VA says.
The OIG created an Opiate Safety Initiative in 2014 to address national and global concerns regarding the use and abuse of narcotics.
At the time the initiative was created, the Poplar Bluff VA provided opiate therapy to about 1,500 veterans each year, local officials say. Very few had urine drug tests or signed consent forms, they explained.
By January 2016, the VA says they had achieved remarkable results.
The number of chronic opioid patients receiving urine drug screens has gone from less than 40 percent in mid-2015 to more than 80 percent since late 2015, according to figures provided by the VA.
The number of patients receiving opioids has been reduced by 5 percent since January 2015, and the number of veterans on long-term opioid therapy is down by 450 people.
The facility has been awarded a $250,000 grant to develop opioid safety programs and procedures. This would include a team to work with primary care providers and working with veterans to find ways to reduce drug reliance and coordinate care.