Reflecting on Leadership, a New Year's reading recommendation list

keywords:  resources, recommended reading, leadership, teamwork, reflection

Recommended Reading on Leadership

(some books also available in audio format)

links and content updated 02.17.2020

For the Healthcare Program Leader, Change-Agent, or Integrative Health program "Champion", and Hospital Sponsor, current and future  

• Duke University Leadership Program white papers on leading change in health care:
• The Pebble in the Pond:  How Integrative Leadership Can Bring About Transformation by Adam Perlman, Bonnie Horrigan, Elizabeth Goldblatt, Victoria Maizes, and Ben Kliger.
• Informed Mindfulness:  The Power of Awareness and Choice in Effective Leadership by Michael Aquilino, Bonnie Horrigan, and Adam Perlman.
• The Leaders of Integrative Healthcare Programs audio and audiovisual resources these are located on our Lunchtime Listens page

• Margaret Heffernan's Beyond Measure, the big impact of small changes, a 2015 TED book
• see how small shifts and behavior changes lay fertile ground for cultural change in the workplace
• Predictable Results in Unpredictable Times by Covey et al.
• Brene Brown's Dare to Lead:  Brave Work. Tough Conversations. Whole Hearts. --added late winter 2019
• Awakening Compassion at Work: The Quiet Power that Elevates People and Organizations by Monica Worline and Jane E. Dutton--added summer 2019
• "A leader who practices mindfulness and self-awareness is a positive force" post
• "Making space for innovation" post
• Subscribe to the Facebook Page to follow the "leadership and workplace Mondays" theme that started in spring 2018.  If you are on a Facebook fast, I just started doing a monthly summary of these social media posts in November 2018.

General Leadership Book Favorites

• Brene Brown's Dare to Lead: Brave Work. Tough Conversations. Whole Hearts. (added late winter 2019)
• Rising Strong:  How the Ability to Reset Transforms the Way We Live, Love, Parent, and Lead
• Beyond Measure, the big impact of small changes
• See how small shifts and changes in behavior lay fertile ground for cultural change in the workplace in Margaret Heffernan's Beyond Measure, the big impact of small changes, a 2015 TED book.
• Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland (added 2.17.2020)

What I am reading or re-reading in 2020

last updated 2.17.2020. Watch our "Leadership & Workplace Mondays" posts for most recent updates

• Brene Brown's Dare to Lead: Brave Work. Tough Conversations. Whole Hearts.
• New website with Dare To Lead resources (added 3.30.2020)
• Scrum: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland (added 2.17.2020)
• Chief Joy Officer: How Great Leaders Elevate Human Energy and Eliminate Fear by Richard Sheridan
• Start with Why: How Great Leaders Inspire Everyone to Take Action by Simon Sinek

Classics--recommended foundational reading

• The classic, The 7 Habits of Highly Effective People by S. Covey
• The book, First Things First by S. Covey, offers not a clock for how to do more in less time, but a compass.
• "...provides you with a compass, because where you're headed is more important than how fast you're going"
• Predictable Results in Unpredictable Times by Covey et al.
• Arianna Huffington's Thrive:  The Third Metric to Redefining Success and Creating a Life of Well-being, Wisdom, and Wonder   
• Primary Greatness: The 12 Levers of Success by Stephen Covey.
• "The intrinsic rewards of primary greatness . . . integrity, responsibility, and meaningful contribution"

If you are looking for related leadership and workplace recommendations in an audio or audiovisual form beyond these books, go to our growing list of Lunchtime Listen recommendations.

What are your favorite books on leadership and why?  Please write in the comments.

related blogposts

The Gift Ideas page

Supporting our Hospital Administrators

Reflective Readings to Inspire Your Health and Wellness

Learning about Mindfulness

The Integrative Medicine Researcher

The Healthcare Provider or Graduate Medical Student
Basics of Being an Employee in a Medium to Large Healthcare System, a video interview series
Reflection & Self-Care Recommended Reading

If you have found these recommendations helpful, please contribute toward the costs of supporting this blog resource and building related resources on our website.

Gift Ideas for the Graduate Medical Student or Health Care Provider

The Graduate Medical Student, Resident, or Practitioner interested in Integrative Health

some gift ideas

list and links updated 02.17.2020

You can request these books from your library, through the Libby app (Overdrive), or buy via the Amazon links. If you follow an Amazon link from this page and buy within a few hours, a few pennies of your purchase goes toward the Hospital Handbook Project. However, if you find this work useful, the best way to support this work is through our "support us" page on the website. Thank you.

Feed Your Mind

• Bates Guide to Physical Examination and History Taking, 12th edition, hardcover. 
• Bates’ Pocket Guide available in paperback and Kindle formats
• Case Studies to Accompany Bates’ Guide available in paperback and Kindle formats
• Integrative Health Clinicians’ Desk Reference, paperback and Kindle editions
• Spark in the Machine
• Vibrational Medicine by Richard Gerber, MD.  Paperback and Kindle formats.
• Mindfulness for Beginners by Jon Kabat-Zinn
• The Educated Heart, a practical guide to professional boundaries by Nina McIntosh
• Griffin's Hospitals:  What They Are and How They Work
• Deepak Chopra books
• Super Brain:  Unleashing the Explosive Power of Your Mind to Maximize Health, Happiness, and Spiritual Well-Being
• Super Genes:  Unlock the Astonishing Power of Your DNA for Optimum Health and Well-Being

Practical Stuff for Work    

Yeti mug

• Yeti Mug—keep your student hydrated and the liquid stays hot or stays cold for the entire clinical shift or study session. 
• Yeti Rambler 20 oz
• 68oz Thermos insulated (by Thermos)
• RFID-blocking wallet--to protect your hospital ID card and other cards (credit cards)
• RFID-blocking wallet, Trayvax company  Such as
• Trayvax Ascent, Trayvax Element, Trayvax Axis, and Trayvax Contour and more at their website.

See the Gift Idea page for more inspiration and links to fair trade coffee and chocolate

Getting Used to the Workplace as an Employee-Clinician

• "Basics of Being an Employee in a Medium to Large Healthcare Setting", a new video interview series recorded in 2019 and going through editing and publication into 2020. Topics in the six videos include: what to expect during employee orientation (onboarding), performance plans & employee evaluations, mentor-relationships and career path mapping, and team communication as a professional clinician
• First Steps (to getting your foot in the door of hospital-based practice) resource (e-booklet + workbook)
• The "New Hospital Employee Resource"
• Follow our "Leadership & Workplace Mondays" theme on our public Facebook Page and the blog article summaries of these posts.

Research Resources for the Hospital-based Clinician

• The "Research & Metrics" theme on our Facebook Page and blog article summaries. 
• Research Literacy and Practical Applications for the Hospital-based Clinician
• Short courses with pdfs on metrics for clinical practice
• How To Use a Validated Pain Scale in Your Clinical Practice
• Calculating Morphine Equivalent Dose (MEQ) for Non-prescribers: Medication Review Standard
• The Integrative Medicine Researcher
• Notes from the 2019 Society of Acupuncture Research (SAR) Conference

If this was useful, please support this community work.  

You can buy me a coffee, sponsor a newsletter, or sponsor a project via the website.

www.thehospitalhandbook.com

The Integrative Medicine Researcher

www.thehospitalhandbook.com

updated 12.15.2018

1. Are you researcher interested in designing studies in the field of integrative health/integrative medicine?
2. Are you an integrative health (IH) program director, designated IH "champion" for your department or facility, or the program lead?
3. Are you a integrative health clinician looking to design your clinical metrics?
4. Or, are you a graduate student looking to understanding more about research in the field?

Each of the above 4 have slightly different resource needs.

• First, no matter which of the 4 you identify as, I recommend you sign up for the email list to have access to our basic resources and be notified of updates in our resources as they are created.  
• Second, if you are not finding what you need through the following resource links, please contact me via the website contact page.  Some resources are still in development.  And, I would like feedback if our resources need some updates or improvements.  Thank you.  

In the spirit of the "gift ideas" and resource recommendations, here is a list of items available through Amazon.  When you follow the Amazon affiliate links on this page and purchase an item within a few hours, a few pennies goes toward the Hospital Handbook Project.  However, several of these resources are not available from Amazon, so we drafted a resource pdf of bibliographies, etc.  If you are interested in that pdf, please contact me through the contact page on the website.

(1) The Researcher interested in Designing Studies in the Integrative Health Field

Books available through Amazon—just follow these links:

• Spark in the Machine:  How the Science of Acupuncture Explains the Mysteries of Western Medicine
• Acupuncture Research:  Strategies for Establishing an Evidence Base by Hugh MacPherson, Richard Hammerschlag, George Lewith, and Schnyer
• Integrating East Asian Medicine into Contemporary Healthcare by Volker Schneid and Hugh MacPherson
• Clinical Research in Complementary Therapies:  Principles, Problems and Solutions by George Thomas Lewith, Wayne B. Jonas, and Harald Walach
• Clinicians’ &Educators’ Desk Reference on the Integrative Health & Medicine Professions by Elizabeth Goldblatt, Pamela Snider, and Beth Rosenthal, and Renee Motheral Clugston
• Science of the Heart, vol. 2 by Rollin McCraty.  The science behind HeartMath (breathing techniques, meditation, brain waves, neuroscience, biofeedback)
• The "Researcher's Resource List"
• This is a pdf compilation of citations of recommend resources for the beginning or established researcher interested in the field of integrative health and particularly acupuncture.  The list has been compiled with feedback from the Hospital practice Handbook Project community.  It contains favorite reads and resources on clinical research design, published research and pilot studies, and common research field issue discussions.  
• If you are interested in this pdf, send me a specific message through the contact page of the website.  

(2) The Integrative Health Program Director or Program Champion

• We have a growing resource list.  The basics are in this post.
• When you are ready to dive deeper and into more specifics for a specialty or program or research and pilot studies in that specific field, please contact us via the website for the "Researcher's Resource List" and other specifics you are interested in, such as published citations of work.
• We recently (2018) started an interview series, to be identified with the keyword tag "interview series".  The first published interview is with Dr. John Burns of Aurora Health system of Wisconsin and their Emergency Department program.  If you, your program, or facility would like to sponsor or co-sponsor this series or similar work, contact me via the website.

www.thehospitalhandbook.com

(3) The Integrative Health Clinician interested in clinical metrics

• Courses:  we are creating short courses on basics of using metrics in clinical practice, based on feedback from the community
• Follow these tags/keywords in the blog and the website: 
• metrics, research literacy, study design, grants and funding, interview series, webinar series
• and look at suggestions in #4 below.

(4) The Graduate Student Looking to Understand more about Research in the Field 

• Check out the ideas at gifts for the graduate medical/healthcare student
• Research review blogposts:  
• 2018 acupuncture and fascia literature review
• biomechanisms of NSAIDs and electroacupuncture pain relief pathways
• Mel Hopper Koppleman and her work with EBA:
• The field of acupuncture research in 10 minutes
• Evidence based Acupuncture and EBA Connect
• Key papers to know when discussing acupuncture with a physician
• Meridians:  Journal of Acupuncture and Oriental Medicine and their Researcher's Resource webpage
• See list from #3 and #1 above and 
• Books on Amazon or your Library
• If you are on a limited (grad student) budget, see if these are available through your local library in physical form or through Overdrive (electronic database public libraries and academic libraries subscribe to) or Libby (app)
• all the books listed in #1 above plus
• Research Design:  Qualitative, Quantitative, and Mixed Methods Approaches, 5th edition by John Creswell
• Evidence-based Nursing:  The Research Practice Connection by Sarah Jo Brown
• Designing Clinical Research by Stephen B. Hulley
• Nursing Research:  Methods and Critical Appraisal for Evidence-based Practice by Geri LoBiondo-Wood, the award-winning 8th edition or the newer 9th edition.  

What is the Researcher's Resource List?

• This is a pdf compilation of citations of recommend resources for the beginning or established researcher interested in the field of integrative health and particularly acupuncture.  The list has been compiled with feedback from the Hospital practice Handbook Project community.  It contains favorite reads and resources on clinical research design, published research and pilot studies, and common research field issue discussions.  If you are interested in this pdf, send me a specific message through the contact page of the website.

Thank you for supporting this work!  You can support this work directly through the website from buying me a cup of coffee while I draft resources, supporting operating costs for a day, or sponsoring a newsletter.  Thank you. 

https://www.thehospitalhandbook.com/support-the-project/

You can follow us by subscribing to this blog, joining the email newsletter list, and following our Facebook page.

Related Information on Resources and/or Gift Ideas

• the Gift Idea page
• Integrative Medicine, the philanthropic movement into Mainstream Medicine--want to learn more?
• Creating Resources to Grow and Connect the Integrative Medicine Community
• Supporting our Hospital Administrators and Department Heads who are incorporating Integrative Medicine and Integrative Health professionals and paradigms into their programs

https://www.thehospitalhandbook.com/support-the-project/

Most Popular Posts of Autumn

Autumn Blogroll Review

For an update on the Hospital Practice Handbook Project work, please see In November, the Chum Salmon Run.

This Autumn, I did a series of posts related to the opioid epidemic as several major reference papers and recommendations for non-pharmacologic therapies from national organizations have come out over the past year.  Currently, the most popular of these posts is The Medication Review and Calculating the Morphine Equivalent Dose (MEQ) which, while reviewing how to recognize common opioid medications, also has links to several good resources on opioid safety training for both allied health and primary care providers.
Medication Review and Review of Systems:  Opioid Med side effects
The White Paper:  Acupuncture's Role in the Opioid Epidemic
Joint Commission Pain Management Standard update
37 Attorney Generals Push Incentives for Non-Pharm Pain Relief Therapy

The Lunchtime Listen series continues to be popular, particularly Duke University's Launching an Integrative Health Program.  Check out the latest installment of the series with Opioid Epidemic.


Previous Blogroll Reviews
Most Popular Posts of the Spring Fundraiser

Lunchtime Listen: The Opioid Epidemic

keywords:  medication review, the opioid crisis, pain management, non-pharm options, the Surgeon General's Call to Action about the Opioid Epidemic, public health crisis, lunchtime listen audiovisual

updated 3.10.2020

Today's Lunchtime Listen recommendation, "Opioid Overdose Epidemic:  A Call to Action" is an audiovisual presentation, supported by the federal Joint Pain Education Project (JPEP), has several statistics about the opioid prescription increase, what the opioid epidemic is, side effects of opioids (pain sensitization, poor sleep), etc.  It mentions the 2016 U.S. Surgeon General's Call to Action about the Opioid Epidemic.    length of video:  about 26 minutes.

While the video is a module intended for prescribing practitioners, it has good information for non-prescribing practitioners to understand when talking with your prescribing colleagues about what you offer as non-pharm pain management therapy options for patients.

"1/4 of patients on long-term use opioids for chronic pain struggle with opioid use disorder"

"In 2014, accidental deaths from opioids exceeded accidental deaths from motor vehicle accidents"

After minute 25, the summary:

"#1.  DO NOT PRESCRIBE OPIOIDS as a FIRST LINE TREATMENT" 

Instead, it is recommended primary care providers consider which non-opioid and non-pharm therapies are appropriate.  

Here's a quick guide about what non-pharm therapies are commonly used in pain programs and how to refer created by several integrative medicine national organizations:  Moving Beyond Medications


Online Modules for Acupuncturists who Treat Pain

• How to Use a Validated Pain Scale in Your Chart Note
• Calculating Morphine Equivalent Dose (MEQ) for Non-prescribers and the Medication Review Standard

Blog articles related to opioid medications and non-pharm options

• Calculating Morphine Equivalent Dose
• Medication Review and ROS:  Opioid Medication Side Effects
• The Autumn 2017 White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
• Metrics and Pain Management:  Using the DVPRS as your Pain Scale

More Lunchtime Learning Recommendations

• Launching an Integrative Health Program in a Medical Center 
• Integrative Medicine Leadership:  Lori Knutson's "Leading Simply in a Complex System" 
• The Complexity of Acupuncture Research in just 10 minutes
• Samueli Institute's On Human Flourishing series
• Research Review:  Key Studies to Understand when Discussing Pain Management with a Physician

If you have found this blog and its posts useful, contribute $5 or $25 today to support this resource (blog and website).  Thank you.  If you or your business/program want to sponsor or co-sponsor a specific project, like the Webinar Series, contact me.  

Do you want to follow our work at the Hospital Handbook Project?  Just join the contact list on the website, subscribe to the blog, and like our Facebook page.

In November, the Chum Salmon Run: Update on the HH Project Work

key words:  project update, fundraising, opioid crisis, online courses

Here in the Pacific Northwest, we have several "runs" of salmon.  Last week I chaperoned a school field trip for my daughter's class where we travelled to Twanoh State Park, where the Olympic mountains meet the southern portion of the Hood Canal. See quick video of it here.

Time for the monthly progress update.   I continue to learn more about the Teachable platform for hosting online courses as we finish up the beta-testing phase of the Workers’ Comp Documentation Toolkit:  (East Asian Medicine) Practitioner’s Perspective.  I designed this course for the WA L&I Acupuncture Pilot Participants to be successful in transitioning to this style of clinical work and the state workers’ comp system of documentation and reimbursement.

I have continued to post short clips of my Hospital Handbook Project work in the blog.  (The book manuscript has more comprehensive information.)   Recently have posted a series of posts related to the current opioid crisis.  The following posts are useful for the patient or patient advocate: 

• Acupuncture's Role in the Opioid Crisis, the white paper
• State Attorney Generals Push for Non-Pharm Pain Relief Therapy options
• The Joint Commission New Pain Management Standard--Non-Drug Pain Management must be available to patients
• The FDA Pain Management Guideline recommends Acupuncture

And these posts are intended for the practitioner:

• any of the above and
• Moving Beyond Medications:  Non-Pharm Approaches to Pain Management and Well-Being  
• The Medication Review:  Calculating Morphine Equivalent Dose (MEQ)
• Medication Review and Review of Systems:  Side Effects of Opioid Medications
• The Field of Acupuncture Research in 10 minutes--a video 

If you missed it, you can still listen (or watch, when there is video), a recommended Lunchtime Learning series from the related blogposts or from the YouTube playlist.

Our Facebook Page is growing.  Please “like” our page and rate it (if you like the information).  You can also send me messages/email through the Hospital Handbook Project Facebook page.

Book progress--I am going through edits of the manuscript and learning more about self-publishing process every month.

Thank you for your support!  

“Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.” –Melody Beattie

The White Paper, Acupuncture's Role in Solving the Opioid Epidemic

keywords:  research literacy, acupuncture for pain relief, acupuncture for pain management, non-pharm pain management options, the opioid epidemic, the cost-effectiveness of acupuncture, the acupuncture analgesia mechanism, acupuncture, and neuroplasticity

"The United States is facing a national opioid epidemic, and medical systems are in need of non-pharmacological strategies that can be employed to decrease the public’s opioid dependence." 

"Acupuncture is an effective, safe, and cost-effective treatment for numerous types of acute and chronic pain. Acupuncture should be recommended as a first line treatment for pain before opiates are prescribed, and may reduce opioid use."

In September 2017, the white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management, was published by The Joint Acupuncture Opioid Task Force, chaired by Bonnie Bolash, MAc.

This white paper is just 15 pages long and incredibly well-referenced (21 pages long when including references section).  You can look at a copy on Evidenced-based Acupuncture's website.

This work was a collaboration of the following national and international organizations:  The American Society of Acupuncturists (ASA), The American Alliance for Professional Acupuncture Safety (AAPAS), The Acupuncture Now Foundation (ANF), The American TCM Association (ATCMA), The American TCM Society (ATCMS), and the National Federation of TCM Organizations (NFTCMO).

All the topics in the paper are supported by research in the endnotes/reference section.
I highlighted some topics with a related quote below.  Check out the full paper here.


For anyone asking, how does acupuncture work?  The paper states,

 "mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives." 

Is acupuncture cost-effective?

"...acupuncture’s cost-effectiveness could dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding the development of opioid addiction that requires costly care, destroys quality of life, and can lead to fatal overdose."

Who recommends it?

"Acupuncture has been recommended as a first line non-pharmacologic therapy by the FDA, as well as the National Academies of Sciences, Engineering, and Medicine in coping with the opioid crisis. The Joint Commission has also mandated that hospitals provide non-pharmacologic pain treatment modalities." [section 4]

"Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacological treatment options, and acupuncture stands as the most evidence-based, immediately available choice to fulfill these calls.  Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of pain seen commonly in hospitals." 

Acupuncture and neuroplasticity

"Acupuncture is effective for the treatment of chronic pain involving maladaptive neuroplasticity" and "acupuncture has the capacity to reverse adverse neuroplastic changes" [section 3]

Source:  The September 2017 white paper, Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management
scientific journal citation:
Fan AY, Miller DW, Bolash B, Bauer M, Faggert S, He H, Li YM, Matecki A, Camardell L, Koppelman MH, Stone J, McDonald J, Meade L, Pang J.  Acupuncture's Role in Solving the Opioid Epidemic:  Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management --White Paper 2017. J Integr Med. 2017; 15(6): 411-425.  http://dx.doi.org/10.1016/S2095-4964(17)60378-9

Simultaneously published in Meridians:  Journal of Acupuncture and Oriental Medicine, winter 2018.  www.meridiansjaom.com

Related blogposts

• Calculating Morphine Equivalent Dose
• Medication Review:  Discerning Side Effects of Opioid Medications
• 37 Attorney Generals Push Incentive Programs for Non-Pharm Pain Management Therapies
• Sept 2017 update on Joint Commission's Pain Management Standard
• The Field of Acupuncture Research in 10 Minutes
• FDA Pain Management Guideline Recommends Acupuncture
• Lunchtime Listen:  the Opioid Epidemic
• Metrics and Pain Management, using a Validated Pain Scale

Useful Infographic on Non-Pharm Pain Relief Options for a PCM

• Moving Beyond Medications:  Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs.  This is a collaborative work by several national integrative medicine groups.

Professional Practice: Discerning Medication Side Effects from Symptoms and Signs

Medication Review and Review of Systems:  Side Effects of Opioid Medications

revised 3.10.2020
This is now available, with other download-able pdfs in this short online course

Keywords:  medication review, documentation standards, professional practice (OPPE), opioids, MEQ, medication side effects, workers’ comp, pain management

Why do you need to know?

It is important and useful for an EAMP to consider the side effects of a patient’s medications.  This helps when going through the assessment, including the Review of Systems (ROS), to discern what is a side effect from a medication (branch or twig) vs. what is endemic to the constitution or specific condition (root and/or earlier branch). 

What is the source of the following information?

The August 2017 CDC online training based on the January 2016 CDC Guidelines on Safe Opioid Prescribing, “Applying CDC’s Guideline for Prescribing Opioids” https://www.cdc.gov/drugoverdose/training/overview/index.html

Common Side Effects of Opioid Use

Constipation	Dry mouth
Drowsiness	Nausea
Confusion	Vomiting
Tolerance/loss of medication effectiveness	Physical dependence
Decreases ability to safely operate equipment	Sexual dysfunction

Red Flags—Be Wary of Opioid Medication + Nervous System Depressants

Benzodiazepines

Drinking alcohol

Why is this a red flag? 

These combinations [opioid + benzodiazepine or opioid + drinking alcohol] can quickly lead to respiratory depression (slowed and stopped breathing)

Serious Risks Associated with Opioid Use

Death	Opioid use disorder
Respiratory depression	Decreased ability to safely operate a vehicle
Unintentional ingestion by household members/others (children)	Overdose

What Conditions Make People at Extra High Risk for Adverse Events or Death d/t Overdose when taking Opioids, according to the 2016 CDC Guideline?

If they have a history of:	Overdose Any sleep disorders Renal or hepatic (liver) problem Alcohol or substance use problem
Age:  65+
Pregnancy (pregnant women)
If they currently have one of the following:	Depression Alcohol or substance use Prescribed over 50 MME/day Taking benzodiazepines Treated with methadone

Reference for the above information:

Source: 2016 CDC Guidelines on Safe Opioid Prescribing.  For the related CEU training, go to the CDC course, Applying CDC’s Guideline for Prescribing Opioids  

Useful Infographic when Communicating with PCM Colleagues about Non-Pharm Pain Relief Options

Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.

Related Blogposts

Calculating Morphine Equivalent Dose (MEQ)
Metrics and Pain Management, using a Validated Pain Scale

More about sleep disturbance as a side effect of opioid medications, see Sleep disturbance in patients taking opioid medication for chronic back pain, published 2016 in the journal Anaesthesia by Robertson and Purple et al.

Biomedicine Review of Opioids

•  “2-Minute Neuroscience: Opioids” by Neuroscientifically Challenged
•  From Speed Pharmacology, published Jan. 28^th, 2019
• “Pharmacology-OPIOIDS (Made Easy)”
• From Dr. Matt & Dr. Mike YouTube Channel:
• “Analgesic Pathway: Endogenous Opioid System”, published Oct. 29^th, 2019.
• “Pain: Pathway and Analgesics (NSAIDs, Opioids, Antidepressants, and Anticonvulsants)”, published May 29^th, 2018
• “Chronic Pain and Sensitization”, published October 27^th, 2019
• “Anti-inflammatory Drugs (NSAIDs and steroids)”, published Nov. 6th, 2016
• “Prostaglandins & NSAIDs” part 1 and “Prostaglandins & NSAIDs” part 2, published April 16th, 2016
•  “Side Effects of NSAIDs”, published October 22^nd, 2019

If you found this information useful, please contribute to this resource via our website.  Thank you.

For full access to this article as a pdf plus several related pdfs, please go to our related short online course on Calculating MED: Medication Review Standard.

copyright Megan Kingsley Gale

Do not reproduce without the author's written permission

The author can be reached through the Hospital Practice Handbook's Facebook Page.  Just use the "message" feature on that Facebook Page.

The Medication Review and Calculating Morphine Equivalent Dose (MEQ)

Calculating Morphine Equivalent Dose (MEQ)

Last updated 2020.03.10
Now available as an online short course with pdf(s)

Keywords:  documentation standards, pain medications, opioid medications, calculating morphine equivalent dose (MED), MEQ, medication review, metrics, pain management, opioids, workers' comp, return-to-work clinic model

Morphine Equivalent Dose Calculation (MEQ)

The morphine equivalent dose is a way of tracking how much opioid-type medication a patient is taking on a daily basis. There are multiple medications that contain morphine, hence the calculation.

MEQ is a useful tool for determining red flags and for tracking (by the individual patient or a general measure of all patients in specific outpatient clinic environment) how much opioid-type pain meds patients are taking before starting EAM treatment vs. when they finish treatment. MEQ data taken at initial and re-evaluations is a useful way to track that info. 

1.    First, do the medication review with the patient.

In a medication review, you take down patient-reported information on prescriptions, over-the-counter meds and supplements.

If the patient is unclear about what they are taking, communicate with the referring provider to get this information. 

[The ACPA has a useful wallet card for patients to track their meds.]

2.    Second, recognize which prescriptions are opioid-based medications.

Names of commonly prescribed opioid medications

Codeine	Fentanyl transdermal
Hydrocodone	Hydromorphone
Methadone	Morphine
Oxycodone	Oxymorphone
Tapentadol	Tramadol

3.    Third, after you have finished the med review, plug the opioid-based prescriptions and daily mg dosages into the online Opioid Conversion calculator to determine the daily morphine equivalent dose (MEQ).  Report/track this number in the MEQ portion in the medication review section of your chart note template.

4.    Fourth, note Red Flags such as MEQs above 50 and medication panels that include opioids plus one or more of the following:  mood drugs, sleep drugs.  For specific medication names and drug classes that warrant red flags, review the WA State Opioid Safety free CEU training.  Know how and when to make appropriate referrals or communication with the referring provider.

Quick double-check: did you remember to ask your patient (who is on an opioid medication), about their pain?  Did you track this on a validated pain scale?  Learn more about pain scales in this post.

Related Resources

• WA State's calculator link (for MEQ) comes with a CEU training for providers about opioid prescriptions 
• Link to more WA State Opioid Safety Resources with some YouTube Videos.
• The CDC Opioid Prescribing Safety Guideline Training, the August 2017 update 
• these guidelines have lowered the red flag MED from 120/day to 50/day
• If you want to dive deeper into this:  The COCA Webinar series with the University of Washington

Primary Care-Specific Resources (Physicians, Nurse Practitioners, PAs)

• All of the above Resources plus
• Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.
• Cautious, Evidenced-Based Prescribing Guidelines by the Physicians for Responsible Opioid Prescribing

Related Short Courses Available with download-able pdfs
all revenue generated from these goes toward sustaining the Hospital Handbook Project, a community resource

• How to use a validated Pain Scale in Your Chart Note
• How to Calculate MEQ and the Medication Review Standard for Non-prescribers

Related Blogposts

• Medication Review and ROS:  Opioid medication side effects
• The White Paper:  Acupuncture's Role in Solving the Opioid Epidemic
• The FDA Pain Management Guideline Recommends Acupuncture
• The Joint Commission Pain Management Standard 2017 Clarification on Non-Drug Pain Relief Therapies
• DVPRS, the validated pain scale designed for the patient-centered, biopsychosocial clinic model

copyright Megan Kingsley Gale

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