Making progress in curbing opioid use in hospitals

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

The opioid epidemic has reached a tipping point. Overdose deaths involving prescription opioids have quadrupled since 1999, as safer pain management practices must be a national priority. Everyone in health care needs to be aware of the potential dangers and become part of the solution. That means partnering with patients and families on pain management expectations; education on safe use, storage and disposal of opioids; and prevention of misuse and abuse after discharge. Clinicians throughout a patient’s full continuum of care also need to increase their awareness to ensure that prescriptions are being written only when absolutely necessary.

Effective, safe pain management requires making time for patient-centric care, so when opioids are prescribed, it is done safely and responsibly. A recent study found 5 to 6 percent of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery. Another study found each refill and additional week of opioid use following surgery was associated with 44 percent increase in rate of misuse. This research highlights the need address risk and optimize pain management in post-operative care when tackling the opioid epidemic.

According to a recent Premier survey, approximately 90 percent of C-suite leaders of health systems are prioritizing strategies to curb opioid use. The survey found the majority of respondents are focusing efforts on:

  • Conducting patient assessments upon admission to evaluate pain levels
  • Providing staff education on resources for safe opioid use and alternative pain relief
  • Engaging in patient education on pain management and safe use of opioids
  • Collaborating with state, local and community partners
  • Using technology for clinical decision support, patient alerts, prescribing practices and continuous electronic monitoring of patient-controlled analgesia.

Uniquely positioned to address important questions on strategies aimed at curbing the growing opioid epidemic in the United States, Premier and American Society of Anesthesiologists (ASA) are working together on a targeted pain management pilot within the CMS-sponsored Hospital Improvement Innovation Network (HIIN), which is designed to provide real-world evidence in the effort to stem the epidemic.  More than 30 hospitals are participating in the pilot — examining best practices around reducing opioid-related adverse drug events and improving safer postoperative pain management.  The pilot is currently focused on patients undergoing elective hip and knee arthroplasty or colectomy procedures within an inpatient setting.

With the pilot still underway, the findings from this work are just now being collected and analyzed.  They are encouraging in terms of changing and improving practices related to pain management and managing care following a procedure.  Outlined below have been key drivers of change and improvement within the program:

  • Use of standardized assessment tools throughout the acute episode of surgical care, including use of patient pre-surgical risk screening, and postoperative pain and sedation assessment tools.
  • Leveraging best practices to improve reliability of care delivery during the hospitalization and for preparing the patient for safer postoperative pain management after discharge from the hospital.
  • Implementing a rapid-cycle performance improvement methodology.
  • Sharing stories by patients and families who have been impacted by opioid misuse and/or addiction that arose as a result of prescribed opioid therapy.
  • Encouraging peer-to-peer sharing of best practices and learnings.

This program has helped raise awareness of the need for safe opioid utilization to prevent misuse and potential for addiction within the institutions we’ve been working with, and is helping reset provider and patient expectations regarding safer postoperative pain management. We are working hand-in-hand with health systems to drive the improvement with the safe use of opioids coupled with reducing opioid-related adverse events, including postoperative respiratory failure and over sedation.

Asokumar Buvanendran is an anesthesiologist. Roshni Ghosh is a physician. 

Image credit: Shutterstock.com

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