Using technology and open minds to cut opioid prescriptions
MetroHealth System’s doctors and nurse practitioners prescribed 3 million fewer opioid pills in the past 18 months by implementing new technology and instituting some cultural changes.
The Cleveland-based hospital network last year launched its Opioid Prescribing Initiative to promote better opioid stewardship among clinicians and to advocate against the misuse and abuse of such drugs throughout the community. The efforts resulted in 33% fewer opioid prescriptions compared with the previous 18 months. That includes a 62% drop in prescriptions for acute pain and a 25% cut in prescriptions for chronic pain.
MetroHealth CEO Dr. Akram Boutros said the plan involved using electronic health records to track clinicians’ prescribing habits and flag patients who were at risk of addiction.
The effort is part of MetroHealth’s response to the opioid epidemic which killed 720 people in Cuyahoga County last year, according to a report from the county’s Medical Examiner’s Office.
Ohio has seen some of the highest drug overdose mortality rates in the country, ranking second behind West Virginia in the rate of overdose deaths in 2016, according to the Centers for Disease Control and Prevention.
“We were able to identify high-risk patients for addiction by looking at internal and external data for things like patients who move to multiple providers, patients who have large amounts of pills provided to them, and those with a history of coming into an emergency room before a prescription should have been out,” Boutros said.
The system’s EHR can recommend non-opioid alternatives, lower opioid dosages or options besides pharmaceuticals for treatment. It also alerts clinicians if they should add a naloxone prescription when opioids are prescribed. Boutros said naloxone prescriptions have risen by 5,000% in the past three months. MetroHealth has saved more than 1,500 people since 2013 by distributing free doses of naloxone through a regional program. The system’s EHR has access to the state’s prescription-drug monitoring programs, which allows clinicians to more easily check on a patient’s prescribing history.
While the use of prescription-drug monitoring programs has grown in recent years, some clinicians fail to use them regularly because in many cases it requires them to use a terminal outside of their EHR, which can be time-consuming and disrupt workflows.
MetroHealth provided extensive training on treating patients with acute and chronic pain through alterna- tives. A simulation program would allow providers to practice how to talk with patients who may be seeking opioids.
A growing number of systems have shifted their focus from opioid treatment to preventing addiction by imposing fiveor seven-day supply limits on painkillers for acute pain not associated with cancer.
But MetroHealth’s initiative goes further. Last July, the system opened its Office of Opioid Safety and last month launched a new Pain and Healing Center to bring together opioid alternatives to help patients handle pain. Psychology and psychiatry services are also offered.
Boutros said the system has also expanded access to addiction treatment. MetroHealth can begin medication-assisted treatment in the ER and over the past year has gone from two to 78 physicians certified to prescribe buprenorphine, which is used to treat addiction.
Late last year the system began working with an organization that hires recovering addicts to help counsel patients who come into the ER with drug addiction. They are on call at the hospital at all times. Boutros expected the program would lead to about 6% of patients entering recovery in the past six months, but the result has been 25%.
In April, the system’s Office of Opioid Safety began deploying two quick response teams made up of social workers and law enforcement to visit overdose patient at their homes in an effort to convince them to enter residential treatment.
“That is a very different relationship between law enforcement and patients who are addicted,” Boutros said. “We just focus on this as a disease and not a character weakness.”