An Institutional Approach to Managing the Opioid Crisis

Abstract

The opioid crisis is a major concern of most health care institutions, including our large academic center. In this article, an organized approach to managing the epidemic institutionally is discussed. An Opioid Stewardship Program was instituted at our tertiary-care center with multiple sites and states of practice, which included diverse membership and expertise. Charges of the program included reviewing current practice, workflows, and external and internal guidelines and evaluating and standardizing prescribing practices. The development of an Opioid Stewardship Program resulted in:(1) an understanding of our diverse prescribing practices and the formation of patient-and procedurespecific guidelines to manage them, (2) education tools for our patients and providers, and (3) workflows and practice advisories within the electronic health record to support appropriate prescribing and monitoring of patients. This ongoing work continues to evolve in response to the needs of our patients, changing regulatory environments, and our improved understanding of our practices.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Another programmatic systems approach to medication management endeavors to create a shared mental model using drug stewardship as a platform of organizational change [ 104 , 105 , 106 , 107 ]. While most stewardship programs have concentrated on rational antimicrobial use [ 108 ], recent developments have focused attention on medication classes that are frequently used in perioperative care and are high-risk for the patient, including opioids [ 109 , 110 , 111 , 112 , 113 ], anticoagulants [ 114 , 115 , 116 , 117 , 118 , 119 , 120 ], anemia management [ 121 , 122 , 123 , 124 , 125 ], and glycemic control with insulin [ 126 , 127 ], among others [ 4 ]. Table 5 summarizes recommendations for preventing VTE, SSI, PONV, POI, and PoD [ 128 ].…”

Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System

“…The formation has the corresponding benefit of simply bringing awareness to prescribing practices. In a description of development procedures for an institution’s OSP, Gazelka et al 33 (2019) noted that the development resulted in an understanding of diverse habits in prescribing and the need to standardize practices, as well as educational tools. Similarly, educational efforts were undertaken under advisement from the OSP in the present study as well, including pain liaison courses for nurses, surgical grand rounds, and medicine grand rounds.…”

Impact of Opioid Prescribing Guidelines on Postoperative Opioid Prescriptions Following Elective Spine Surgery: Results From an Institutional Quality Improvement Initiative

“…The present study represents the culmination of several quality improvement initiatives aimed at reducing postoperative opioid prescribing. 17 Prior to guideline development, a retrospective analysis of postoperative opioid prescriptions following the 25 most commonly performed elective surgical procedures was performed; 2 of which were relevant to spine surgery (lumbar laminotomy and lumbar laminectomy). 14 A wide variation in prescription practices for both procedures was found with the majority of patients (>80%) receiving an opioid prescription in excess of 200 MMEs.…”