Frankly, Peter Holden, president and CEO of Beth Israel Deaconess Hospital in Plymouth, Mass., is sick of people dying in his community.
There’s a deadly epidemic of heroin and pain pill use raging across the nation, killing thousands of Americans every month. It’s been particularly acute in the commonwealth where Holden works, with nearly 1,300 drug overdose deaths in 2014, an uptick of 19 percent compared with that of the previous year.
Looking to tackle health care’s new demands of keeping patients healthy and out of the hospital, Holden quickly realized that he couldn’t do so without addressing the opioid epidemic. As we explored in our March cover story, he and his Massachusetts peers formed a statewide task force and hammered out a list of nine best practices to improve the management of opioid use in hospital emergency departments. During a webinar with the American Hospital Association Tuesday, Holden detailed how using these recommendations has helped Beth Israel to drop the number of painkillers prescribed in its ED by 25 percent.
“I would tell you that we are making a difference,” Holden says. “In my own community, I am just getting sick and tired of going to wakes and funerals for people of all ages who have succumbed to the opiate and heroin crisis, and I hope it is not as bad in your communities, but it mushroomed in ours.”
Those nine best practices are as follows. You can read them all in greater detail on the Massachusetts Hospital Association’s website.
- Hospitals, in conjunction with emergency department personnel, should develop a process to screen for substance misuse that includes services for brief intervention and referrals to treatment programs for patients who are at risk for developing, or who actively have, substance use disorders.
- When possible, ED providers or their delegates should consult the Massachusetts Prescription Monitoring Program before writing an opioid prescription.
- Hospitals should develop a process to share the emergency department visit history of patients with other providers and hospitals that are treating the patients in the ED by using a health information exchange system.
- Hospitals should develop a process to coordinate the care of patients who frequently visit EDs.
- For acute exacerbations of chronic pain, the ED provider should notify the patient’s primary opioid prescriber or primary care provider of the visit and the medication prescribed.
- Emergency department providers should not provide prescriptions for controlled substances that were lost, destroyed or stolen. Furthermore, ED providers should not provide doses of methadone for patients in a methadone treatment program unless the dose is verified with the treatment program and the patient’s ED evaluation and treatment has prevented them from obtaining their scheduled dose.
- Unless otherwise clinically indicated, ED providers should not prescribe long-acting or controlled-release opioids, such as OxyContin, fentanyl patches and methadone.
- When opioid medications are prescribed, the ED staff should counsel the patient: to store the medications securely, not share them with others, and dispose of them properly when their pain has resolved; to avoid using the medications for nonmedical purposes, and to avoid using opioids and concomitant sedating substances because of the risk of overdose.
- As clinically appropriate and weighing the feasibility of timely access for a patient to appropriate follow-up care and the problems of excess opioids in communities, ED providers should prescribe no more than a short course and minimal amount of opioid analgesics for serious acute pain, lasting no more than five days.
As noted in our cover story, all 51 Massachusetts Hospital Association members with EDs have now put these recommendations in place. They’re hoping to complete Phase 2, putting similar best practices in place at hospital and health system outpatient clinics, by the end of this month. In the coming months, Phase 3 will target private medical offices.
Steven Defossez, M.D., vice president of clinical integration at the MHA, believes it’s possible for providers in any state to demonstrate similar success in curbing the opioid epidemic. To do so, however, it’s crucial that you set aside any stigmas about addiction, and involve all key stakeholders in the process, from patients to the chief executive.
“Please don’t think it will be easy,” Defossez says. “Change is always difficult, but given that we all went into health care in order to improve people’s lives, with the right leadership, we can own this problem and become part of the solution.”