Review
CURES and regimen review
California CURES review as clinically indicated, reconciled against the discharge regimen — including the common case of a hospital-only order that should not have carried forward.
Opioid stewardship
Conservative-first pain management, documented
Skilled nursing facilities carry real exposure on controlled substances: residents admitted on regimens nobody started, indications that were never written down, and surveyors who will ask. A pain specialist in the building resolves that, resident by resident.
Indication
A documented reason
Every continued controlled substance gets a stated indication, a target, and a review interval in the chart. That is what is most often missing when a record is questioned.
Alternatives
Non-opioid options first
Topicals, adjuvants, positioning, bracing, therapy-coordinated approaches and targeted interventional options, so a taper is an exchange rather than a subtraction.
Taper
Deprescribing with a plan
Reductions written as a schedule with monitoring, not an abrupt stop, and not a taper forced on a resident whose pain genuinely requires treatment.
Stewardship is not the same as withholding. The aim is the lowest effective regimen a resident's condition allows, with the reasoning visible in the record either way.
Written and clinically reviewed by Raj Desai, MD, Medical Director · Updated