Champlain Valley Physicians Hospital (CVPH) Emergency Department (ED) physicians are working to prevent more patients from becoming addicted. Daniel Anhalt, MD, explains how data and technology help to meet the needs of patients while reducing exposure to opioids.
There is no one solution to addressing the opioid crisis in the North Country, but the University of Vermont Health Network – Champlain Valley Physicians Hospital (CVPH) Emergency Department physicians are working to prevent more patients from becoming addicted. Over the past nine months, the team has reduced the amount of opioids prescribed and administered to patients by 40%.
“The opioid crisis in our community is real and it’s affecting thousands of lives,” explained Daniel Anhalt, MD, MBA, of the CVPH Emergency Department team. Of the 51 counties in New York State (NYS), Clinton County (where CVPH is located) had the second-highest opioid prescription rate, according to the NYS Department of Health’s 2017 data. Among the people taking the most opioids, only 3% of them got their prescriptions from ED physicians, but studies reveal that it’s in the emergency room that many patients have their first exposure to opioids. About 6% of patients (1 in 20) introduced to opioids for a minor self-limiting procedure are still taking them after 180 days, according to a study published in the Journal of American Medicine (2017).
Dr. Anhalt and a team of ED physicians, nurses and analysts believed it was the right thing to do to develop a comprehensive, tech-enabled approach to reducing opioid prescribing in the ED. “Finding a way to reduce exposure while assuring that we are meeting the needs of patients who come to us in pain was our goal,” he explained.
First the team designed a menu of drugs and treatments that are alternatives to opioids. That list is hardwired into the Emergency Department’s computer system, offering physicians’ easy access. They completely eliminated one drug, dilaudid, from the automated medication dispensing system. “We made the decision to no longer use it,” he said. Dilaudid is morphine-derivative painkiller which is said to produce a high similar to heroin. It is known for its strong potential for addiction and abuse.
If patients leave the ED with an opioid prescription, it is only for three to five days-worth of medication. “After three days of taking an opioid, the risk of dependence goes up every day thereafter,” Dr. Anhalt said.
“Educating patients about the options available to them to manage pain and talking about the risks of opioids in general has been a large part of the process, too,” Dr. Anhalt said, adding that the entire ED team plays a role in managing the expectations of patients and their families. Posters offered by the Centers for Disease Control and Prevention are displayed in the department’s exam rooms and waiting room to help reinforce the ED team’s message.
The plan also includes looking at data to determine how many opioids are being prescribed. The first week of each month, the providers review data about the milligram morphine equivalents – overall amount of opioids – being prescribed per patient seen by ED physicians. “It gives us all real-time information about what we were prescribing,” he said. Dr. Anhalt said there are monthly discussions among providers about opioid prescribing. Not only does the approach help keep the initiative on “the radar,” tracking prescription rates has been shown to help hospitals reduce the amount of opioids they prescribe overall.
“There are times when an opioid is needed – it’s the appropriate prescription for the patient; however, offering options when an opioid may not be necessary is our goal,” Dr. Anhalt said.
This story was reported by Christine Shanley Blake, with the UVM Health Network.