Staff participates in statewide reduction program to change the paradigm
By Kristy Acuff
The Gunnison Valley Health emergency room staff reduced the amount of opioids they administer in the emergency department by 31 percent over six months as part of a state-wide pilot program to address opioid abuse. GVH was one of ten hospitals participating in the Colorado Opioid Safety Pilot, which sought to reduce opioid use by 15 percent among the participating hospitals; GVH more than doubled the expected reduction.
“The program focused on providing alternative pain medications and educating our patients about the risks of opioid use,” said GVH’s Jay McMurren, M.D., a leader in the program. “Our results are a credit to our emergency room physicians who are aware of the health issues associated with opioid use and they are dedicated to creating a healthier community in the Gunnison Valley.”
According to Gina Lambert, director of GVH’s emergency department, “The pilot program trained our staff about alternatives to opioids and then provided us with a handbook of sorts, which we could reference. Basically, it guided us step by step through the alternatives to opioids and it was specific for each diagnosis.”
“More often than not, a patient’s first experience with narcotics comes from an emergency room visit,” says Amy Magnus, medical staff and risk coordinator for GVH. “The old practice was always ‘If the patient is in pain, treat with narcotics first.’ But we are changing that paradigm.”
While opioids have typically been used for all types of pain, the guidelines from the pilot program address different drugs for specific types of pain such as kidney stones, migraines, back spasms, abdominal pain, broken bones and dislocations, and acute or chronic pain. Instead of a blanket approach of administering opioids, emergency room staff members are able to pinpoint specific pain relief for each diagnosis.
The program was developed and first implemented by Dr. Don Stader and pharmacist Rachael Duncan of Denver’s Swedish Medical Center. Stader and his team at Swedish conducted their own study using alternatives to opioids before reaching out and training staff at ten Colorado emergency rooms and hospitals.
According to Magnus, part of the training included a riveting story recounted by one physician. “He told us of a time when he was attending to an opioid overdose patient and asking her about her opioid use, trying to get some background. The patient told him that the first time she tried opioids was when she was 15 years old and treated for an ankle fracture. She said she was immediately hooked.” Later, the physician realized that he had been her attending physician for her fractured ankle and it was he who first prescribed the opioids.
“That was a powerful story,” says Magnus.
According to data from the Colorado Department of Health Care Policy and Financing, in 2015 approximately one Coloradan died every 36 hours from opioid overdose. Colorado has the 12th highest rate of misuse and abuse of prescription opioids across all 50 states. Additionally, risk from illicit drugs has increased, and in 2016, heroin overdose deaths across the state increased by 23 percent from 2010. Opioids administered by clinicians sometimes serve as a gateway drug to illicit drugs, such as heroin, according to the Colorado Hospital Association’s Opioid Safety Pilot Program Results Report.
Now, before issuing opioids for pain, emergency room staff administers the first alternative suggested by the alternatives handbook based on the specific medical condition. If that doesn’t work, the document guides them to a suggested second step and if they still haven’t found pain relief for the patient, they complete an “addiction risk assessment” to judge the tendency for patient proclivity to addiction before finally administering opioids as a last resort.
“Participating in the program cements our passion to continually source healthier solutions that will ultimately make a difference to the Gunnison Valley Community,” said GVH’s CEO Rob Santilli.
Magnus reports that patient satisfaction actually increased during the six-month run of the pilot program. “We collected patient satisfaction scores to see if there was a negative impact when we reduced opioid administration, but the scores actually increased,” says Magnus. “Part of the new protocol is more communication with the patients—sitting down and explaining the risks and telling patients why we don’t want to administer opioids—and I think that helped increase patient satisfaction.”
All ten of the participating hospitals and emergency departments exceeded the goal of reducing opioids by 15 percent, and, on average, the cohort of hospitals reduced opioid administration by 36 percent, the equivalent of 35,000 fewer opioid uses.
Nationally, Colorado U.S. Senators Michael Bennet (D) and Cory Gardner (R) introduced the Alternatives to Opioids (ALTO) in the Emergency Department Act to fund innovative approaches to combat the opioid epidemic. The legislation would establish a program to test alternative pain management protocols to limit the use of opioids in hospital emergency departments similar to the Colorado pilot program. It would also provide grant funding to build these programs.
Bennet said, “We need to invest in data-driven, innovative programs like the Colorado Opioid Safety Collaborative Pilot, which has successfully used alternatives to opioids as first-line treatment for pain.”