Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad, DNP, FNP-BC, FNAP

Second Advisor

Lene Heinlen, DO

Third Advisor

Robert Johnson, MD


Chronic pain is the most prevalent health condition in the United States and is the most common reason people seek healthcare (Chang, Daubresse, Kruszewski & Alexander, 2014). In 2012, health care providers wrote 259 million prescriptions for opioid pain medications despite little change in self-reported pain prevalence (Centers for Disease Control and Prevention (CDC) 2016; Chang et al., 2014). Initiatives to prevent the under treatment of pain have resulted in overreliance on opioids to treat pain. As a consequence of opioid centric prescribing, an opioid epidemic has evolved with devastating consequences such as dependence, addiction and overdose deaths related to opioid overuse (CDC, 2016). Due to increased reliance on opioids for chronic non-malignant pain management, the need for a chronic non-malignant pain protocol for a primary care clinic was identified. Baseline data gathered to determine prescribing practices of a rural primary care practice revealed a need for an evidence-based protocol to comply with State of Michigan opioid laws. The protocol included evidence-based education, protocol and electronic health record dashboard development and process evaluation. Implementation of a chronic non-malignant pain protocol resulted in a decrease in opioid-only prescribing in primary care and a 53% increase in multi-modal prescribing practices in a subsequent office visit for 141 patients over eight weeks. In addition, there was a significant increase in adherence with mandated opioid prescribing practices such as: completed urine drug screen monitoring (p < 0.0001), signed opioid start talking forms (p < 0.0001), clinician reviewed drug prescription monitoring (PDMP) (p < 0.0001) and chronic non-malignant pain contracts (p <0.0001). There was no change in the documentation of patients pain score. Implementation of an evidence-based chronic non-malignant pain management protocol that adheres to Michigan law while decreasing opioid-only prescribing results in significant quality improvement in healthcaredelivery for primary care patients.

Additional Files

J. Kipp Powerpoint.pdf (1204 kB)