Id: opioidcds-06 Url: Recommendation #6 - Prescribe Lowest Effective Dose and Duration Version: 2022.1.0 Identifier: value: cdc-opioid-guidance Name: PlanDefinition_Recommendation_06_Order_Sign Title: Recommendation #6 - Prescribe Lowest Effective Dose and Duration Status: draft Experimental: true Type: system: http://terminology.hl7.org/CodeSystem/plan-definition-type code: eca-rule display: ECA Rule Date: 2025-08-06 Publisher: Centers for Disease Control and Prevention (CDC) Description: When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Logic Definitions: Library Name Name sequence OpioidCDSREC06 Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions 0 define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription ) and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription) Library Name Name sequence OpioidCDSREC06 Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain 1 define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain": exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" ) Library Name Name sequence OpioidCDSCommonConfig Age Less than 18 Years Is Enabled 2 // CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true Library Name Name sequence OpioidCDSRoutines Patient Age Less Than 18 3 define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false Library Name Name sequence OpioidCDSCommonConfig Sickle Cell Check Enabled 4 // Sickle Cell define "Sickle Cell Check Enabled": true Library Name Name sequence OpioidCDSCommonConfig Sickle Cell Assumed Active 5 define "Sickle Cell Assumed Active": true Library Name Name sequence OpioidCDSCommon US Core-Categorized Conditions 6 // 3. Medications indicating end of life /* or exists ( "Medications Indicating End of Life" ) */ define "US Core-Categorized Conditions": [Condition: category in "Encounter Diagnosis Condition Category"] union [Condition: category in "Problem List Condition Category"] union [Condition: category in "US Core Health Concern Condition Category"] Library Name Name sequence OpioidCDSCommon Positive Sickle Cell Condition 7 define "Positive Sickle Cell Condition": if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" and C.clinicalStatus in "Active Condition" ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" ) else null Library Name Name sequence OpioidCDSRoutines Condition Positive for Sickle Cell 8 define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false Library Name Name sequence OpioidCDSCommonConfig Active Cancer Treatment Encounters Condition Is Enabled 9 // Active Cancer Treatment define "Active Cancer Treatment Encounters Condition Is Enabled": true Library Name Name sequence OpioidCDSRoutines Encounter Period 10 // End of Opioid Naive Routine /* ** Routine #3 ** Active Cancer Treatment Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** --------------------------------------------------------------------------------------------------------------------------------- ** Two office visits within the | No | Look for a minimum of two distinct | Office Visit ** past 12 months | | encounters within 12 months of the date | ** | | of the current visit for which each of the | ** | | following is true: | ** | | - the encounter diagnosis (primary or | ** | | secondary or co-morbidity diagnosis) | ** | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits with an | No | The encounter is performed by an | Oncology specialty ** oncology specialist | | oncologist as defined in the oncology | designations (NUCC) ** present | | specialty designations using the | ** | | National Uniform Claim Committee | ** | | (NUCC) classifications | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer ** malignant cancer | | secondary or co-morbidity diagnosis) | conditions ** condition | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** ---------------------------------------------------------------------------------------------------------------------------------- ** */ define "Encounter Period": Interval[Today() - 12 months, Today()) Library Name Name sequence OpioidCDSCommon USCore Encounter Cancer Diagnoses 11 define "USCore Encounter Cancer Diagnoses": [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions" Library Name Name sequence OpioidCDSRoutines Encounters with Cancer Diagnosis During Encounter Period 12 // encounter-diagnosis, problem-list and health-concern Conditions // define "US Core-Categorized Cancer Diagnoses": // Common."US Core-Categorized Conditions" C // where C.code in Common."CDC malignant cancer conditions" // define "Encounters with Cancer Diagnosis During Encounter Period": // [Encounter] Encounter // with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis // such that date from Encounter.period."start".value in day of "Encounter Period" // and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id) define "Encounters with Cancer Diagnosis During Encounter Period": [Encounter] Encounters where date from Encounters.period."start" in day of "Encounter Period" and exists ( Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id) ) Library Name Name sequence OpioidCDSRoutines Number of Encounters with Cancer Diagnosis During Encounter Period 13 define "Number of Encounters with Cancer Diagnosis During Encounter Period": Count ("Encounters with Cancer Diagnosis During Encounter Period") Library Name Name sequence OpioidCDSRoutines Has Two or More Encounters with Cancer Diagnosis During Encounter Period 14 define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period": "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2 Library Name Name sequence OpioidCDSCommon USCore Problem List Cancer Diagnoses 15 define "USCore Problem List Cancer Diagnoses": [Condition: category in "Problem List Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions" Library Name Name sequence OpioidCDSRoutines Has Active Cancer Diagnosis on Problem List 16 define "Has Active Cancer Diagnosis on Problem List": exists ( Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses where CancerDiagnoses.category in Common."Problem List Condition Category" and exists( CancerDiagnoses.clinicalStatus.coding ClinicalStatus where ClinicalStatus.code ~ 'active' ) ) Library Name Name sequence OpioidCDSRoutines Is Active Cancer Treatment? 17 define "Is Active Cancer Treatment?": if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" or "Has Active Cancer Diagnosis on Problem List" else false Library Name Name sequence OpioidCDSCommonConfig End-Stage Disease Criteria Enabled 18 // CDC 2022 General Inclusion Criteria define "End-Stage Disease Criteria Enabled": true Library Name Name sequence OpioidCDSRoutines Conditions Likely Terminal for Opioid Prescribing 19 define "Conditions Likely Terminal for Opioid Prescribing": if (Config."End-Stage Disease Criteria Enabled") then exists ( Common."US Core-Categorized Conditions" EOLC where EOLC.code in Common."Conditions likely terminal for opioid prescribing" // and EOLC.clinicalStatus in Common."Active Condition" ) else false Library Name Name sequence OpioidCDSRoutines CDC 2022 Guideline General Inclusion Criteria 20 define "CDC 2022 Guideline General Inclusion Criteria": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Is Active Cancer Treatment?" and not "Conditions Likely Terminal for Opioid Prescribing" Library Name Name sequence OpioidCDSREC06 Order is for Long-Acting Opioid 21 define "Order is for Long-Acting Opioid": exists ( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential" or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days ) Library Name Name sequence OpioidCDSREC06 Inclusion Criteria 22 define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain" and Routines."CDC 2022 Guideline General Inclusion Criteria" and "Order is for Long-Acting Opioid" Library Name Name sequence OpioidCDSREC06 Exclusion Criteria 23 define "Exclusion Criteria": false Library Name Name sequence OpioidCDSREC06 Is Recommendation Applicable? 24 define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria" Library Name Name sequence OpioidCDSCommon Is Opioid Analgesic with Ambulatory Misuse Potential? 25 define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>): ("Get MedicationRequest Medication as Code"(value)) Rx where Rx.medication in "Opioid analgesics with ambulatory misuse potential" and Rx.category in "Community" Library Name Name sequence OpioidCDSCommon Get MedicationRequest Medication as Code 26 define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>): value Rx let Med: if Rx.medication is Reference then singleton from ( [Medication] M where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/'))) ) else null return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest } Library Name Name sequence FHIRHelpers ToString 27 define function ToString(value string): value.value Library Name Name sequence FHIRHelpers ToConcept 28 define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value } Library Name Name sequence FHIRHelpers ToCode 29 define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value } Library Name Name sequence OpioidCDSRoutines Is Acute Pain Prescription? 30 // End of For Subacute or Chronic Pain Routine /* ** Routine #5 ** For Acute Pain Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ----------------------------------------------------------------------------------------------------------------------------------- ** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with ** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential ** potential of duration < 28 | | potential of duration < 28 days | ** days | | | ** ----------------------------------------------------------------------------------------------------------------------------------- ** */ // should allow DateTime precision, but not working in the Ruler specifically define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest): prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days Library Name Name sequence OpioidCDSCommon GetDurationInDays 31 define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' } when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' } when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' } when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' } when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' } when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' } when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null') else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value) end Library Name Name sequence OpioidCDSRoutines Acute Pain Prescription Greater Than 7 Days? 32 // should allow DateTime precision, but not working in the Ruler specifically define function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest): prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days Library Name Name sequence FHIRHelpers ToDateTime 33 define function ToDateTime(value dateTime): value.value Knowledge Capability: shareable computable executable publishable Use Context: code value display focus 182888003 Medication requested (situation) focus 274663001 Acute pain (finding) Purpose: The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care. Usage: When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances. Copyright: © CDC 2016+. Related Artifacts: Documentation 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain Libraries: Library - Recommendation #6 - Prescribe Lowest Effective Dose and Duration Actions: When Treating Acute Pain, Prescribe No More Opioids Than Needed: Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids.#xD; #xD; For guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6). When: Named Event: order-sign If: Applicability: Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if the 2022 CDC guideline general inclusion criteria is met (Is Recommendation Applicable?) Then: : Document - Will adjust opioid order Then: : Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months Then: : Snooze* - N/A see comment, snooze 3 months Then:
Value set Opioid analgesics with ambulatory misuse potential
Value set Encounter Diagnosis Condition Category
Value set Problem List Condition Category
Value set US Core Health Concern Condition Category
Value set CDC malignant cancer conditions
Value set Conditions likely terminal for opioid prescribing
Value set Extended release opioid with ambulatory misuse potential
Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions
define "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions": ( Common."Is Opioid Analgesic with Ambulatory Misuse Potential?"( ContextPrescriptions ) ) AmbulatoryOpioidPrescription where Routines."Is Acute Pain Prescription?"( AmbulatoryOpioidPrescription ) and Routines."Acute Pain Prescription Greater Than 7 Days?"(AmbulatoryOpioidPrescription)
Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain
define "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain": exists( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" )
// CDC 2022 General Inclusion Criteria define "Age Less than 18 Years Is Enabled": true
define "Patient Age Less Than 18": if (Config."Age Less than 18 Years Is Enabled") then AgeInYearsAt(Today()) < 18 else false
// Sickle Cell define "Sickle Cell Check Enabled": true
define "Sickle Cell Assumed Active": true
// 3. Medications indicating end of life /* or exists ( "Medications Indicating End of Life" ) */ define "US Core-Categorized Conditions": [Condition: category in "Encounter Diagnosis Condition Category"] union [Condition: category in "Problem List Condition Category"] union [Condition: category in "US Core Health Concern Condition Category"]
define "Positive Sickle Cell Condition": if Config."Sickle Cell Check Enabled" and not Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" and C.clinicalStatus in "Active Condition" ) else if Config."Sickle Cell Check Enabled" and Config."Sickle Cell Assumed Active" then ( "US Core-Categorized Conditions" C where C.code in "Sickle Cell Diseases" ) else null
define "Condition Positive for Sickle Cell": if (Config."Sickle Cell Check Enabled") then exists( Common."Positive Sickle Cell Condition" ) else false
Active Cancer Treatment Encounters Condition Is Enabled
// Active Cancer Treatment define "Active Cancer Treatment Encounters Condition Is Enabled": true
// End of Opioid Naive Routine /* ** Routine #3 ** Active Cancer Treatment Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** --------------------------------------------------------------------------------------------------------------------------------- ** Two office visits within the | No | Look for a minimum of two distinct | Office Visit ** past 12 months | | encounters within 12 months of the date | ** | | of the current visit for which each of the | ** | | following is true: | ** | | - the encounter diagnosis (primary or | ** | | secondary or co-morbidity diagnosis) | ** | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits with an | No | The encounter is performed by an | Oncology specialty ** oncology specialist | | oncologist as defined in the oncology | designations (NUCC) ** present | | specialty designations using the | ** | | National Uniform Claim Committee | ** | | (NUCC) classifications | ** --------------------------------------------------------------------------------------------------------------------------------- ** Office visits including CDC | No | The encounter diagnosis (primary or | CDC malignant cancer ** malignant cancer | | secondary or co-morbidity diagnosis) | conditions ** condition | | is listed in the CDC Malignant Cancer | ** | | Conditions value set | ** ---------------------------------------------------------------------------------------------------------------------------------- ** */ define "Encounter Period": Interval[Today() - 12 months, Today())
define "USCore Encounter Cancer Diagnoses": [Condition: category in "Encounter Diagnosis Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
Encounters with Cancer Diagnosis During Encounter Period
// encounter-diagnosis, problem-list and health-concern Conditions // define "US Core-Categorized Cancer Diagnoses": // Common."US Core-Categorized Conditions" C // where C.code in Common."CDC malignant cancer conditions" // define "Encounters with Cancer Diagnosis During Encounter Period": // [Encounter] Encounter // with "US Core-Categorized Cancer Diagnoses" CancerDiagnosis // such that date from Encounter.period."start".value in day of "Encounter Period" // and EndsWith(CancerDiagnosis.encounter.reference, Encounter.id) define "Encounters with Cancer Diagnosis During Encounter Period": [Encounter] Encounters where date from Encounters.period."start" in day of "Encounter Period" and exists ( Common."USCore Encounter Cancer Diagnoses" CancerDiagnoses where EndsWith(CancerDiagnoses.encounter.reference, Encounters.id) )
Number of Encounters with Cancer Diagnosis During Encounter Period
define "Number of Encounters with Cancer Diagnosis During Encounter Period": Count ("Encounters with Cancer Diagnosis During Encounter Period")
Has Two or More Encounters with Cancer Diagnosis During Encounter Period
define "Has Two or More Encounters with Cancer Diagnosis During Encounter Period": "Number of Encounters with Cancer Diagnosis During Encounter Period" >= 2
define "USCore Problem List Cancer Diagnoses": [Condition: category in "Problem List Condition Category"] CancerDiagnoses where CancerDiagnoses.code in "CDC malignant cancer conditions"
Has Active Cancer Diagnosis on Problem List
define "Has Active Cancer Diagnosis on Problem List": exists ( Common."USCore Problem List Cancer Diagnoses" CancerDiagnoses where CancerDiagnoses.category in Common."Problem List Condition Category" and exists( CancerDiagnoses.clinicalStatus.coding ClinicalStatus where ClinicalStatus.code ~ 'active' ) )
define "Is Active Cancer Treatment?": if (Config."Active Cancer Treatment Encounters Condition Is Enabled") then "Has Two or More Encounters with Cancer Diagnosis During Encounter Period" or "Has Active Cancer Diagnosis on Problem List" else false
// CDC 2022 General Inclusion Criteria define "End-Stage Disease Criteria Enabled": true
Conditions Likely Terminal for Opioid Prescribing
define "Conditions Likely Terminal for Opioid Prescribing": if (Config."End-Stage Disease Criteria Enabled") then exists ( Common."US Core-Categorized Conditions" EOLC where EOLC.code in Common."Conditions likely terminal for opioid prescribing" // and EOLC.clinicalStatus in Common."Active Condition" ) else false
CDC 2022 Guideline General Inclusion Criteria
define "CDC 2022 Guideline General Inclusion Criteria": not "Patient Age Less Than 18" and not "Condition Positive for Sickle Cell" and not "Is Active Cancer Treatment?" and not "Conditions Likely Terminal for Opioid Prescribing"
define "Order is for Long-Acting Opioid": exists ( "Acute Pain Opioid Analgesic with Ambulatory Misuse Potential Prescriptions" AmbulatoryOpioidPrescription where AmbulatoryOpioidPrescription.medication in Common."Extended release opioid with ambulatory misuse potential" or Common.GetDurationInDays( AmbulatoryOpioidPrescription.dispenseRequest.expectedSupplyDuration ) > 7 days )
define "Inclusion Criteria": "Patient Is Being Prescribed Opioid Analgesic with Ambulatory Misuse Potential for Acute Pain" and Routines."CDC 2022 Guideline General Inclusion Criteria" and "Order is for Long-Acting Opioid"
define "Is Recommendation Applicable?": "Inclusion Criteria" and not "Exclusion Criteria"
Is Opioid Analgesic with Ambulatory Misuse Potential?
define function "Is Opioid Analgesic with Ambulatory Misuse Potential?"(value List<MedicationRequest>): ("Get MedicationRequest Medication as Code"(value)) Rx where Rx.medication in "Opioid analgesics with ambulatory misuse potential" and Rx.category in "Community"
Get MedicationRequest Medication as Code
define function "Get MedicationRequest Medication as Code"(value List<MedicationRequest>): value Rx let Med: if Rx.medication is Reference then singleton from ( [Medication] M where M.id = (Last(Split((Rx.medication as FHIR.Reference).reference, '/'))) ) else null return MedicationRequest { id: Rx.id, status: Rx.status, intent: Rx.intent, category: Rx.category, medication: if Rx.medication is Reference then Med.code else Rx.medication as CodeableConcept, subject: Rx.subject, authoredOn: Rx.authoredOn, recorder: Rx.recorder, dosageInstruction: Rx.dosageInstruction, dispenseRequest: Rx.dispenseRequest }
define function ToString(value string): value.value
define function ToConcept(concept FHIR.CodeableConcept): if concept is null then null else System.Concept { codes: concept.coding C return ToCode(C), display: concept.text.value }
define function ToCode(coding FHIR.Coding): if coding is null then null else System.Code { code: coding.code.value, system: coding.system.value, version: coding.version.value, display: coding.display.value }
// End of For Subacute or Chronic Pain Routine /* ** Routine #5 ** For Acute Pain Routine ** ** Definition | Answer to Proceed | Details | Data (Terminology) Requirement ** ----------------------------------------------------------------------------------------------------------------------------------- ** Order for opioid analgesics | Yes | Look for an existing prescription (order) for | Opioid analgesics with ** with ambulatory misuse | | opioid analgesics with ambulatory abuse | ambulatory misuse potential ** potential of duration < 28 | | potential of duration < 28 days | ** days | | | ** ----------------------------------------------------------------------------------------------------------------------------------- ** */ // should allow DateTime precision, but not working in the Ruler specifically define function "Is Acute Pain Prescription?"(prescription FHIR.MedicationRequest): prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
define function GetDurationInDays(value FHIR.Duration): if value is null then null else case when value.code.value ~ 'a' then System.Quantity{ value: value.value.value * 365.0, unit: 'days' } when value.code.value ~ 'mo' then System.Quantity{ value: value.value.value * 30.0, unit: 'days' } when value.code.value ~ 'wk' then System.Quantity{ value: value.value.value * 7.0, unit: 'days' } when value.code.value ~ 'd' then System.Quantity{ value: value.value.value, unit: 'days' } when value.code.value ~ 'h' then System.Quantity{ value: value.value.value / 24.0, unit: 'days' } when value.code.value ~ 'min' then System.Quantity{ value: value.value.value / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 's' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0, unit: 'days' } when value.code.value ~ 'ms' then System.Quantity{ value: value.value.value / 60.0 / 60.0 / 24.0 / 1000.0, unit: 'days' } when value.code.value is null then Message(1000, true, 'Undefined', 'Error', 'Duration unit code is null') else Message(1000, true, 'Undefined', 'Error', 'Unsupported duration unit code: ' + value.code.value) end
Acute Pain Prescription Greater Than 7 Days?
// should allow DateTime precision, but not working in the Ruler specifically define function "Acute Pain Prescription Greater Than 7 Days?"(prescription FHIR.MedicationRequest): prescription.dispenseRequest is not null and prescription.dispenseRequest.expectedSupplyDuration is not null and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) > 7 days and Common.GetDurationInDays( prescription.dispenseRequest.expectedSupplyDuration ) < 28 days
define function ToDateTime(value dateTime): value.value
Recommendation #6 - Prescribe Lowest Effective Dose and Duration
Centers for Disease Control and Prevention (CDC)
When opioids are needed for acute pain, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids.
The 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain is intended to improve communication between clinicians and patients about the benefits and risks of pain treatments, including opioid therapy; improve the effectiveness and safety of pain treatment; mitigate pain; improve function and quality of life for patients with pain; and reduce risks associated with opioid pain therapy, including opioid use disorder, overdose, and death. The recommendations do not apply to pain related to sickle cell disease or cancer or to patients receiving palliative or end-of-life care.
When the diagnosis and severity of acute pain warrant use of opioids, clinicians should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. For many common causes of nontraumatic, nonsurgical pain, when opioids are needed, a few days or less are often sufficient, and shorter courses can minimize the need to taper opioids to prevent withdrawal symptoms at the end of a course of opioids. However, durations should be individualized to the patient's clinical circumstances.
2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain
When Treating Acute Pain, Prescribe No More Opioids Than Needed
Please verify that the opioid order quantity and duration are no more than needed for the expected duration of pain severe enough to require opioids. For guidance regarding prescribing opioids for acute pain, see [Recommendation 6 of the 2022 CDC Clinical Practice Guideline](https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm#Recommendation6).
Check whether the current order is for an opioid with ambulatory misuse potential for acute pain with an intended duration of more than 7 days and if the 2022 CDC guideline general inclusion criteria is met
Snooze* - Benefits of opioid therapy duration outweigh risks, snooze 3 months
Snooze* - N/A see comment, snooze 3 months