Alison Partridge, MSN, RN, CPAN;
Nancy Butters, MS, APRN, CCRN-K, ACNS-BC;
Carin Hosler, BSN, RN
Reducing Opioid Consumption
while Improving Pain Assessment
and Management through
Evidence Based Practice
Initiatives
Opioid Epidemic:
In healthcare and in our community
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Clinical and Cost Outcomes of Opioid-
Related Adverse Drug EventsIn a study conducted by JAMA that included 135,379 patients, 14,386 (10.6%) experienced opioid-related adverse drug events.
Events were associated with negative patient outcomes including
✓ Increased inpatient mortality (2.9% increase)
✓ Extended length of stay (1.6 day increase)
✓ Greater likelihood to discharge to another care facility
✓ Higher cost hospitalization ($8,225)
✓ Higher rate of 30 day readmission
** JAMA Surg. Published online May 23, 2018. doi:10.1001/jamasurg.2018.1039 3
Meeting the New TJC Guidelines
Team Approach of multispecialty and multidisciplinary support
• Pharmacy, Nursing, Administration, IT, Physicians, Data Management, and Project Management
• Exceptional support from Physician and Nurse Administration
• Enabled us to move quickly, approve changes, and start protocols 4
November 2017 formal team
January 84% Functional
April 2018 100% Functional
2018 Accomplishments
• Developed an opioid exposure assessment
• Multimodal pain management tailored to a
patients opioid exposure
• Implemented the Comfort Function Goal
• Reinforced and reeducated all disciplines on best
practices.
• Developed a scorecard to quantify improvements
• Significant opioid reduction numbers
• Recognized by TJC surveyors as best practice 5
Opioid Naïve• No, or very little, opioid exposure presently or in the past
Opioid Tolerant • Current opioid treatment for greater than 7 days
• Previous extended exposure to opioids
Opioid Complex• Previous or current drug or alcohol abuse
• Long-term opioid treatment with persistent pain
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Pre-Anesthesia Opioid Exposure
Assessment
Multimodal Order Sets
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Medications✓ Tylenol, Celebrex, Gabapentin, Valium, Ketamine
Therapy✓ Physical Therapy, Distraction Therapy, Aromatherapy, Cold
Therapy, Music Therapy, Heat Therapy
Nerve Blocks✓ Blockade of painful nerve signals to the brain with local
anesthetic injections
Comfort Function Goal
Work with patient to establish a realistic pain goal
• Assess once per shift
• How much pain can be tolerated without interfering with
function?
• Acute pain-post-op pain is anticipated but identify pain
level to make a painful activity tolerable
• Persistent pain-may not expect pain to be under 5
which can interfere with function
0 may not be possible
Set realistic expectations
8
Reinforced EBP in Place Already
Assess/reassess at proper intervals based on:
• Potency
• Route
• Onset
• PEAK
• Duration
Monitoring Capabilities
• SPO2
• ETCO2
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5 Factors That Drive Dose
Selection for Analgesics
• Pain intensity, progress toward pain goal,
characteristics of pain
• Patient characteristics (risk factors)
• Pharmacokinetics of the drug; use of other
sedating medication
• Sedation level (POSS score)
• Prior response to opioids or other analgesics
10
Discharge Instructions
• Teach opioid safety
• Use
• Storage
• Disposal
11
2018 Scorecard
12
Opioid Reduction Data
13
35%
25%27%
Overall opioid doses administered in 2018
was reduced 35% for the entire system.
Patients who received opioids, required less.
Our Incredible Team
Dr. Stan Wilson (Executive Sponsor)
Dr. Jeffrey Frohock (Physician Leader)
Francis Wyckoff (Director of Pharmacy)
Jason Little (Project Management)
Kim Gaillard and Julie Lawrence (Pharmacy)
Alison Partridge and Nancy Butters (Nursing)
Suha Malhi (Revenue Cycle)
Stacey Seipel (Quality)
Carin Hosler (Pharmacy/Nursing Liaison)
Nancy Morrow and Jean Clark (Accreditation)
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References• Meisenberg, B., Ness, J., Rao, S., & Rhule, J. (2017). Implementation of solutions to reduce opioid-
induced oversedation and respiratory depression. American Journal Of Health-System Pharmacy,
74(3), 162-169. doi:10.2146/ajhp160208
• Pasero, C. & McCaffery, M. (2011). Pain Assessment and pharmacologic management. St. Louis,
Mosby Elseveir.
• The Joint Commission (2012). Safe Use of opioids in hospitals. The Joint Commission Sentinel Event
Alert. 49, 1-5.
https://www.jointcommission.org/assets/1/18/R3_Report_Issue_11_Pain_Assessment_8_25_17_FIN
AL.pdf
• Jarzyna, D., Jungquist, C. R., Pasero, C., Willens, J. S., Nisbet, A., Oakes, L., … Polomano, R. C.
(2011). American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced
Sedation and Respiratory Depression. Pain Management Nursing.
https://doi.org/10.1016/j.pmn.2011.06.008
• Jungquist, C. R., Smith, K., Wiltse Nicely, K.L., Polomano, R. C. (2017). Monitoring Hospitalized
Adult Patients for Opioid-Induced Sedation and Respiratory Depression UNINTENDED ADVANCING
SEDATION AND RESPIRATORY DEPRESSION. American Journal of Nursing, 117(3), 27–35.
• Centers for Medicare & Medicaid Services (2014). Requirements for Hospital Medication
Administration, Particularly Intravenous (IV) Medications and Post-Operative Care of Patients
Receiving IV Opioids. Center for Clinical Standards and Quality/Survey & Certification Group.
• Cooney, M., & Broglio, K. (2017). Acute Paint Management in Opioid-tolerant Individuals. The
Journal for Nurse Practitioners, 394-399.
• Dahan, A., Aarts, L., & Smith, T. W. (2010). Incidence, Reversal, and Prevention of Opioid-induced
Respiratory Depression. Anesthesiology, 112(1), 226–238.
https://doi.org/10.1097/ALN.0b013e3181c38c25
• Dahan, A., Overdyk, F., Smith, T., Aarts, L., & Niesters, M. (2013). Pharmacovigilance: a review of
opioid-induced respiratory depression in chronic pain patients. Pain Physician, 16(2), E85-94.
Retrieved from
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Thank you!
