Nine Ways EDs Can Curb the Opioid Epidemic

Massachusetts Hospital Association issues guidelines

Peter Holden, president and CEO of Beth Israel Deaconess Hospital in Plymouth, Massachusetts, and his peers recently formed a statewide task force under the auspices of the Massachusetts Hospital Association (MHA) and compiled a list of nine best practices to improve the management of opioid use in hospital emergency departments (EDs). During a webinar with the MHA, Holden detailed how using these recommendations has helped Beth Israel cut the number of painkillers prescribed in its ED by 25%. 

Those nine best practices are as follows:

  1. Hospitals, in conjunction with ED personnel, should develop a process to screen for substance misuse that includes services for brief intervention and referrals to treatment programs for patients who are at risk for developing, or who actively have, substance use disorders.
  2. When possible, ED providers or their delegates should consult the Massachusetts Prescription Monitoring Program before writing an opioid prescription.
  3. Hospitals should develop a process to share the ED visit history of patients with other providers and hospitals that are treating the patients in the ED by using a health information exchange system.
  4. Hospitals should develop a process to coordinate the care of patients who frequently visit EDs.
  5. For acute exacerbations of chronic pain, the ED provider should notify the patient’s primary opioid prescriber or primary care provider of the visit and the medication prescribed.
  6. ED providers should not provide prescriptions for controlled substances that were lost, destroyed, or stolen. Furthermore, ED providers should not provide doses of methadone for patients in a methadone treatment program unless the dose is verified with the program and the patient’s ED evaluation and treatment has prevented them from obtaining their scheduled dose.
  7. Unless otherwise clinically indicated, ED providers should not prescribe long-acting or controlled-release opioids, such as OxyContin, fentanyl patches, and methadone.
  8. When opioid medications are prescribed, the ED staff should counsel the patient to store the medications securely, not share them with others, and dispose of them properly when their pain has resolved; to avoid using the medications for nonmedical purposes; and to avoid using opioids and concomitant sedating substances because of the risk of overdose.
  9. As clinically appropriate and weighing the feasibility of timely access for a patient to appropriate follow-up care and the problems of excess opioids in communities, ED providers should prescribe no more than a short course and a minimal amount of opioid analgesics for serious acute pain lasting no more than five days.

All 51 MHA members with EDs have put the recommendations into effect. They are hoping to complete phase 2––adopting similar best practices at hospital and health-system outpatient clinics––by the end of this month. In the coming months, phase 3 will target private medical offices.

Source: H&HN; March 9, 2015; and MHA; February 26, 2015.