Welcome to the June Issue of
HIIN The Know
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In this month's
HIIN The Know
, we focus on opioid stewardship and related adverse drug events (ADEs). Despite significant strides made in reducing opioid use, Medicare beneficiaries (65 and older) are often discharged from the hospital with new opioid prescriptions, and they often remain on opioid medication for extended periods (90 days) after discharge.
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Considering this information, we still have a long way to go.
One in-patient best practice is the Enhanced Recovery After Surgery (ERAS) protocol and the use of multimodal order sets to reduce the use of opioids in the perioperative setting. A meta-analysis concluded that ERAS programs are associated with significant reduction in length of stay, total complications, and total costs.
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Despite these benefits, there appears to be great variation as to the extent of use and implementation.
However, one HSAG HIIN hospital is achieving great success. To date, it is performing 80 percent of all surgeries opioid free and has reduced narcotic use by 90 percent. Equally important, there has been significant improvement in patient satisfaction, length of stay, and post-operative readmissions. This success has been achieved using an ERAS protocol that includes a multimodel pain plan, regional blocks, and continuous peripheral never blocks.
As part of the HSAG HIIN, your hospital has access to opioid stewardship and ADE resources to support your efforts. Please reach out to your Quality Advisor to receive your personalized, no-cost assistance today!
References:
- Agency for Healthcare Research and Quality. (2017). Patient safety and opioid medications. PSNet. Available at: https://psnet.ahrq.gov/perspectives/perspective/215/patient-safety-and-opioid-medications. Accessed on: June 4, 2019.
- Lau, C.S. & Chamberlain, R.S. (2017, April). Enhanced recovery after surgery programs improve patient outcomes and recovery: A meta-analysis. World Journal of Surgery, 41(4), 899-913. Doi: 10 1007/s00268-016-3807-4
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HSAG HIIN Hospitals' Current Opioid Progress
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Improvement Tools and Resources
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Opioid-Related ADE Field Guide
This field guide contains valuable opioid-related ADE information including the harm impact of opioids, the opioid measure, known improvement strategies, and specific resources.
Click here to view the field guide.
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Centers for Medicare & Medicaid Services (CMS)—March 2019 Roadmap: Fighting the
Opioid Crisis
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ERAS
®
Society List
of Guidelines
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Support for Hospital Opioid Use Treatment (SHOUT) Toolkit
This toolkit is based on published evidence and expert opinion to model one particular way of increasing and improving access to care for patients with opioid use disorder (OUD).
Click here to view the toolkit.
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Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for
Chronic Pain
This guideline provides recommendations for clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. The guideline addresses when to initiate or continue opioids for chronic pain—opioid selection, dosage, duration, follow-up, and discontinuation—assesses risk and addresses harms of opioid use
.
Click here to view the guideline.
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Institute for Safe Medication Practices (ISMP)—Medication Safety Self Assessment
®
for High-Alert Medications
This tool, funded by the U.S. Food and Drug Administration, offers all healthcare settings a unique opportunity to assess the safety of systems and practices associated with up to 11 categories of high-alert medications. ISMP defines high-alert medications as those bearing a heightened risk of causing significant patient harm when used in error.
Click here to view the self assessment.
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The Data Advantage Corner
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Hospital Readmissions and HAI Feedback Reports
Now Available!
The hospital readmissions report provides a summary of your hospital’s Medicare Fee-for-Service (FFS) readmissions data through Q4 2018 and provides overall and stratified readmission rates—allowing your hospital to identify key areas of focus. The healthcare-associated infection (HAI) report provides an overall summary of HAI measures and an update on your hospital’s National Healthcare Safety Network (NHSN) data from Q1 2018 through Q4 2018.
To find your hospital’s readmissions and HAI feedback reports:
- Log in to the HSAG HIIN Secure Data Portal.
- Select the Reports tab.
- Locate your hospital’s report within the Readmission or HAI Reports drop-down menu.
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Upcoming Events and Education
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PFE Think Tank: Hospital-Acquired Pressure Injuries (HAPIs)
Tuesday, June 18, 2019
12 noon to 1 p.m. PT
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Critical Access and Rural Hospital Workgroup: Post-Sepsis Syndrome and Driving Improvement in Sepsis Outcomes
Thursday, June 20, 2019
12 noon to 1 p.m. PT
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Opioids: The Painful Truth
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Join HSAG for a day of learning on June 25 or July 10. Select one—the program is the same for both dates/locations.
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Who Should Attend:
Leaders and clinicians
from:
- Acute care hospitals
- Behavioral health hospitals
- Post-acute care settings
- Community organizations
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Learning Objectives:
- Analyze the OUD disease process, its natural course, and how treatment alters it.
- Explore the national and California landscapes of the opioid crisis.
- Identify challenges and misperceptions regarding opioid use and treatment.
- Discover interventions, resources, and clinical practices to improve person-centered care.
- Share success stories and reinforce continued efforts to find solutions.
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Pasadena—Tuesday, June 25, 2019
Pasadena Convention Center
300 E. Green St.
Pasadena, CA 91101
8 a.m.–3 p.m. PT
Cost: $25 per person
(covers parking, breakfast, lunch, and all-day beverages)
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Sacramento—Wednesday, July 10, 2019
Center at Twenty-Three-Hundred
2300 Sierra Blvd.
Sacramento, CA 95825
8 a.m.–3 p.m.
Cost: $25 per person
(covers parking, breakfast, lunch, and all-day beverages)
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Presented by HSAG and HSAG HIIN, in partnership with:
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Continuing Education (CE): Health Services Advisory Group, Inc., is the CE provider for these events. Provider approved by the Board of Registered Nursing, Provider Number 16578, for 5 contact hours. Application has been made to the California Nursing Home Administrator Program, #CEP1729, for 5 continuing education credits, pending approval.
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2. Lembke A, Chen J. Use of Opioid Agonist Therapy for Medicare Patients in 2013.
JAMA Psychiatry
. 2016; 73(9): 990–992.
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Share a best practice or noteworthy story with the HSAG HIIN community. What you do makes a difference, so please share!
Striving for Opioid Free Pain Control After Surgery
Thomas Mark, MD, works as an anesthesiologist in the Department of Anesthesia at SUMMA Health System in Akron, Ohio.
Click here
to view the strategies and best practices used by Dr. Mark and SUMMA Health System to reduce opioid use
and manage pain after surgery.
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