June 2013
IN THIS ISSUE

• Record-Keeping Tips
• Assessment of Practices where Methadone Administration is Delegated
• Naloxone
• Suboxone and Buprenorphine Training
• Other questions about the MMT Program Standards and Clinical Guidelines?

1. Subjective, Objective, Assessment, and Plan (SOAP) format
2. Documentation of patient counselling
3. Details about the plan for the patient at each visit
4. Differentiation from patient to patient and from note to note.

Many physicians using an Electronic Medical Record (EMR) find it easier to use a template or to copy the last note; however, this does not ensure that the visit is well documented.

This checklist will help you document what is important:

1. The SOAP format is preferred for all interactions and patient visits including those for methadone treatment. For more information about the SOAP format, see the College’s Medical Records policy.
2. Notes should reflect what was discussed at each appointment. Counselling around family issues, school issues, work place problems, current stresses, etc. is a big part of what prescribers do as part of the clinical interaction and needs to be fully documented.
3. Each note for each patient should include a variety of information. If different notes from different patients all look the same, there is not enough detail about the physician-patient interaction.
4. Each note should include a detailed plan. While the prescription provides some information about the plan, you must include sufficient detail in the progress note to “tell the story” of the patient. If another physician sees your patient issues that have been discussed, the past management of this patient and the future plan must be clearly documented.

Delegation of Methadone Administration
The delegation exemption was established by Health Canada as a way to address issues regarding patient access to methadone. If you are a physician with a delegation exemption, you are ultimately responsible for the patient’s treatment. You must be satisfied that anyone you delegate has the knowledge, skill and judgment to do the task.

When physicians receive a delegation exemption, they agree to a joint review of the practice by both the College of Physicians and Surgeons of Ontario and the Ontario College of Pharmacists (OCP). An inspector from the OCP is hired by the CPSO to assess the following:

• Documentation (e.g. policies and procedure manuals, agreements for delegation)
• The transportation and transfer of custody of methadone, and the safe/secure storage of methadone
• Methadone dose reconciliation
• Record keeping practices (See Record Keeping Tips)
• Appropriate return of unused doses

• Naloxone: the basics
• What you need to start a Naloxone program
• How to prescribe Naloxone
• Risks and Liabilities
• Medical Directives and Protocols
• Supplies: what you need and where to get them
• Training lay-people to administer Naloxone

• Naloxone Information Session
• Naloxone Peer Training Video

MMT Program Standards and Clinical Guidelines
Many of you know that the College has a Methadone phone line. The phone line was established for the following purposes:

1. To provide patients with the names of methadone prescribers in their community who might be accepting new patients;
2. To confirm a physician’s methadone exemption for pharmacists;
3. To respond to questions from physicians interested in applying for a methadone exemption for opioid dependence.

In addition to calls regarding these issues, we receive calls from prescribers with questions about the MMT standards and guidelines. Some of these questions are straightforward and staff can respond to them. Others are reviewed by the Methadone Committee and may make their way into the Q&A section of Methadone News.

If you have a question about the MMT standards and guidelines, please email: tmarshall@cpso.on.ca or mgans@cpso.on.ca.

We will determine if staff can respond, or if the matter requires a review by the Committee.