Monday, October 23, 2017

The Medication Review and Calculating Morphine Equivalent Dose (MEQ)


Calculating Morphine Equivalent Dose (MEQ)
Last updated 2017.10.24

Key words:  documentation standards, pain medications, opioid medications, calculating morphine equivalent dose (MED), MEQ, medication review, metrics, pain management, opioids, workers's 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 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 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 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 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


Primary Care-Specific Resources (Physicians, Nurse Practitioners, PAs)
copyright Megan Kingsley Gale
Do not reproduce without the author's written permission

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