Re­think­ing pain med­i­ca­tion

Hos­pi­tal ER cuts back on opi­ates

Connecticut Post (Sunday) - - News - By R. A. Schuetz rschuetz@ hearst­medi­act. com; @ raschuetz

When doc­tors in the Norwalk Hos­pi­tal Emer­gency Depart­ment pull up their elec­tronic care plan sys­tem on a com­puter, next to the most com­mon pa­tient ail­ments is a new op­tion: “nonopi­ate.”

When the op­tion is clicked, the sys­tem lists alternatives to opi­ate­based treat­ments. It’s part of the hos­pi­tal’s re­cent opi­oid ini­tia­tive aimed re­duc­ing the amount of opi­ates the emer­gency depart­ment or­ders for use in- house. In the past two years, it suc­ceeded dra­mat­i­cally — the amount of opi­ates the depart­ment or­dered nearly halved, drop­ping by 46 per­cent.

Ben­jamin Green­blatt, chair­man of the emer­gency depart­ment, said the ini­tia­tive was the depart­ment’s re­sponse to the opi­oid pan­demic.

“You can’t ig­nore it, right?” he said. “It’s in the news­pa­pers, it’s in the news, it’s in the lit­er­a­ture — whether in the throw­away mag­a­zines or the peer- re­viewed jour­nals. It is just ev­ery­where.”

How­ever, when one of the depart­ment’s physi­cians, Chris Mi­chos, be­gan ad­vo­cat­ing for an opi­oid ini­tia­tive, Green­blatt was un­sure how much the depart­ment could re­duce its opi­ate or­der­ing. It had been years since the staff had learned about the dan­gers of opi­ates.

“Had we al­ready changed our or­der­ing habits?” he asked.

When the data came in this Jan­uary, two years af­ter the ini­tia­tive be­gan, it be­came clear that the new mea­sures had made a sig­nif­i­cant im­pact. “The num­ber was a lot big­ger than we ever thought it was go­ing to be,” Green­blatt said of the drop.

In ad­di­tion to chang­ing the elec­tronic care plan sys­tem, the depart­ment in­vited guest speak­ers and ed­u­cated staff on the lat­est re­search and prac­tices. Mi­chos vis­ited St. Joseph’s Health­care Sys­tem, which has New Jersey’s busiest emer­gency depart­ment, to learn best prac­tices af­ter it also launched an alternatives to opi­ates pro­gram ( St. Joseph’s re­ported a 58 per­cent drop in opi­oid pre­scrip­tions within a year).

The goal, staff said, was not to elim­i­nate opi­ate or­ders but to re­duce un­nec­es­sary use.

“With Dr. Green­blatt’s sup­port, a col­lab­o­ra­tive team in­clud­ing my­self, nurs­ing and phar­macy met to in­clude ev­i­dence­based new treat­ments and to uti­lize stan­dard med­i­ca­tions that, based on new re­search, was as ef­fec­tive as opi­oid med­i­ca­tion with­out the side ef­fects and risk of ad­dic­tion,” Mi­chos said.

Con­tin­ued ed­u­ca­tion is im­por­tant be­cause med­i­cal con­sen­sus shifts over time.

“When I trained, if some­one had a lot of pain, it was Per­co­cet, Val­ium,” Green­blatt said ( both are nar­cotics). In the in­ter­ven­ing years, stud­ies showed that Tylenol and Motrin can work to­gether to be as ef­fec­tive as a Per­co­cet and could be com­bined with other non- opi­ate treat­ments, such as mus­cle re­lax­ers, steroids and heat­ing pads.

“From our point of view, it’s a much safer way of do­ing things,” Green­blatt said. He pointed out that the ini­tia­tive was a very low­cost way of re­duc­ing opi­ate or­ders. “So the idea would re­ally be to scale it up through the net­work.”

Kather­ine Michael, a psy­chi­a­trist and med­i­cal di­rec­tor of com­mu­nity health at the West­ern Con­necti­cut Health Net­work, of which Norwalk Hos­pi­tal is part, said Norwalk Hos­pi­tal’s opi­ate ini­tia­tive fits in with other ways the net­work ad­dresses the opi­oid pan­demic. For ex­am­ple, the net­work looks for flags that pa­tients may have sub­stance- abuse prob­lems and pairs such pa­tients with spe­cial­ists who have worked through sim­i­lar is­sued them­selves. “Es­sen­tially the way I think about it is we’re try­ing to bring treat­ment of this prob­lem into ev­ery­thing that we do,” Michael said.

As Green­blatt left his of­fice, Brian McGovern, an at­tend­ing emer­gency depart­ment physi­cian, came up and be­gan qui­etly up­dat­ing him on a pa­tient who had come in that day. The pa­tient was aching from a virus, and his fam­ily had re­quested nar­cotics to ease the dis­com­fort.

“A lot of the time, peo­ple come here for us to take care of their pain,” he said. “And you have to be care­ful about how you do that.”

McGovern said he had pointed the fam­ily to a host of alternatives with lesser po­ten­tial side ef­fects than a nar­cotic and ex­plained that the re­cent ini­tia­tive had made it eas­ier for him to do so.

“I feel now I have a back­ing to say no.”

Erik Traut­mann / Hearst Con­necti­cut Me­dia

Dr. Ben Green­blatt, chair of Emer­gency Medicine at the Bauer Emer­gency Care Cen­ter at Norwalk Hos­pi­tal. The Emer­gency Depart­ment man­aged to re­duce the or­der­ing of opi­oids by 45 per­cent within one year through a screen­ing and ed­u­ca­tion ini­tia­tive. Staff hopes that their prac­tices will set an ex­am­ple for other hos­pi­tals to fol­low to re­duce the un­nec­es­sary pre­scrip­tion of opi­oids. Be­low, Dr. Green­blatt looks at treat­ment plans.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.