Guiding Appropriate Opioid Use Through Quality and Safety Efforts

Through numerous quality and safety efforts, we're helping to curb the inappropriate use of opioids and boost outcomes for patients.

Setting Opioid Guidelines and Pain Management Standards

Atrium Health created a taskforce in 2017 to focus on the development of standard tools and resources to support the appropriate use of opioids. The taskforce of about 50 comprises stakeholders from across the system, including medication safety, musculoskeletal, behavioral health, rehabilitation and emergency services.

Its aims include developing a standard pain agreement and guidelines to assist providers in the discussion and treatment of patients with chronic pain, as well as a resource list for providers and teammates available on our intranet.

Using our centralized electronic health records, the taskforce also developed an innovative opioid dashboard that allows medical directors to identify trends in prescribing habits across different locations and specialties. Providers, too, use the dashboard to track their prescribing practices and ensure they’re within risk guidelines set by the government. Armed with this information, Atrium Health can quickly address problems within our system where rates of opioid prescriptions exceed the average.

Implementing Alternative Pain Management Methods

The opioid taskforce initiated alternative pain management mechanisms to help prevent the overuse of opioids, including a tool for the ambulatory setting. The tool suggests pain medications outside of opioids that can safely be prescribed for various conditions, from knee pain to migraine prevention, as well as the option to intermix non-medication therapies, such as massage and acupuncture, to help patients manage their pain.

The group successfully implemented protocols involving the following modalities to help patients manage their pain beyond opioids:

• Cryotherapy
• Aromatherapy
• Guided imagery
• Massage and reiki therapy
• Multimodal pain pathways

Measuring Reversals of Opioid Overdoses

Atrium Health has taken part in all CMS Partnership for Patients contracts, including the Hospital Engagement Network and Hospital Improvement Innovation Network (HIIN). These contracts focus on sustaining and accelerating national progress toward continued harm reduction, including adverse drug events and readmissions, and encouraging innovative ways to approach patient safety and harm.

Through the HIIN contract, Atrium Health established an ambitious outcomes metric around the number of reversals for opioid over-sensation using Naloxone, a medication to prevent overdose by opioids. The HIIN goal was for each hospital to decrease the use of Naloxone by 20 percent from a baseline value in 2015. Atrium Health has reduced the use by 30-40 percent and current work is to maintain the success while educating patients about how to safely take opioids.

Aligning Across the System

Internally, to keep providers up to date on Atrium Health’s pain management recommendations as well as public policy impacting prescribing practices, the medication safety team launched an educational intranet page in 2017. Through this page, providers receive instructive information and links related to acute and chronic pain prescribing, assessment, multimodal alternative therapy, and the appropriate disposal of controlled drugs to prevent diversion. The resource page also directs controlled substance prescribers to new CMS requirements.

Moving forward, the Quality Division will continue to focus on improving responsible prescribing through data analytics and process development. Upcoming efforts include expanding the partnership with Atrium Health’s behavioral health service line around prevention of opioid use disorder; advancing data analysis to identify opportunities for intervention; collaborating with health IT company Cerner on tools for providers in the electronic medical record; and enhancing the information available to providers and patients online, as with the educational opioids webpage.