Medication safety – the opioid opportunity
From crisis to solution
There has been significant recent national media attention on our country’s opioid crisis. With our own state in focus, Florida Gov. Rick Scott declared this as a public health emergency last May. Drug overdose deaths, particularly those involving opioids, have continued to increase. According to the Centers for Disease Control and Prevention, six out of every 10 of these drug-related deaths involve an opioid.
The CDC also has identified that overdoses from prescription opioids directly relate to these disturbing numbers. This data also demonstrates that between 1999 and 2010, the amount of prescription opioids sold to pharmacies, hospitals and doctors’ offices has nearly quadrupled. Statistics show that in 2015, six times more opioids per resident were prescribed in high-prescribing counties than in the lowest-prescribing ones. This provides an opportunity to improve education and change protocols to address the lack of consistency in prescribing habits.
Recent efforts have intensified to educate and train medical students and clinicians on how to more effectively and appropriately prescribe opioids and educate patients. Several UF College of Medicine resident physicians here at UF Health have tackled this issue and are working toward identifying opportunities to help our patients. Notably, David Hall, M.D., general surgery resident; Kevin Olsen, M.D., anesthesiology resident; Juan Mira, M.D., general surgery resident; and Patrick Underwood, M.D., general surgery resident, have identified opportunities to better educate surgical staff in effective opioid prescribing.
One success story involves a significant drop in narcotic pain medications prescribed to patients undergoing colorectal surgery after implementing a new quality improvement initiative. Fewer patients received oral narcotics during their hospital stay and fewer discharged patients received prescriptions for narcotic pain medication. Overall, the total dosages of all inpatient and outpatient narcotic medications dropped from 2,481 mg to 307 mg of morphine-equivalent dose, or MED, following the new protocol.
Some characteristics of counties with higher opioid prescribing:
- Small cities or large towns
- Higher percentages of white residents
- More dentists and primary care physicians
- More people who have diabetes, arthritis or disability
Source: Centers for Disease Control and Prevention
This initiative — led by Atif Iqbal, M.D., an assistant professor of general surgery — is part of an enhanced recovery after surgery, or ERAS, protocol introduced at UF Health in mid-2015. It aims to reduce complications and readmissions and improve quality of care delivered to colorectal surgery patients. Under the ERAS protocol, before surgery, patients receive an epidural catheter along with oral gabapentin, a nerve pain medication, and oral ibuprofen. During the procedure, they receive IV acetaminophen, and post operatively they are given oral acetaminophen, ibuprofen and titrated doses of oral gabapentin.
Underwood will be working this summer with medical students supported by the UF College of Medicine’s Medical Student Research Program. These projects will allow us to embrace these issues in the journey to deliver the best possible care to our patients and communities. UF Health has also introduced a Multidisciplinary Pain Committee of faculty and staff who share insights and resources to help improve pain management safety. They focus on developing tools to help frontline staff identify, recognize, assess and manage patients’ pain needs. The Joint Commission standards ensure these criteria are met to successfully tackle this issue.
How UF Health approaches pain management in compliance with The Joint Commission
New and revised pain assessment and management standards are set for The Joint Commission-accredited hospitals. These standards are outlined in the Leadership; Medical Staff; Provision of Care, Treatment and Services; and Performance Improvement chapters of the hospital accreditation manual. Here are the new standards at a glance:
- Identify pain assessment and pain management, including safe opioid prescribing, as an organizational priority.
- Actively involve medical staff in leadership roles in organization performance improvement activities to improve quality of care, treatment, services and patient safety.
- Assess and manage the patient’s pain and minimize the risks associated with treatment.
- Collect data to monitor performance
- Compile and analyze data.
These standards were pulled from The Joint Commission R3 Report —Requirement, Rationale, Reference.