Cannon, Robert D., DO

Freling, Alec, MS4

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTMultifactorial Approach to Opioid Abuse Withinthe Emergency DepartmentAlec Freling MS4USF MCOM- LVHN CampusRobert D. Cannon DOLehigh Valley Health Network, Robert_D.Cannon@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtFreling, A. Cannon, R. D. (2018, March). Multifactorial Approach to Opioid Abuse Within the Emergency Department. Poster Presentedat: 2018 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon, Lehigh Valley Health Network, Allentown, PA. © 2018 Lehigh Valley Health NetworkIntroductionMethodsResults Opioids are medications often utilized in the emergency setting for acute pain management. The overuse and/or misuse of opioid medications over the past two decades has significantly contributed to the current opioid addiction crisis in the United States. This presents an opportunity for emergency departments to implement opioid-prescribing policies to combat the rise in opioid addiction. As such, Lehigh Valley Health Network (LVHN) has adopted an opioid-prescribing guideline, entitled “Prescribing Opioid Pain Medication and Controlled Substances in the Emergency Department”, which aims to standardize the role of opioids in treating pain in the emergency setting. To assess providers’ awareness and perception of the policy, an online survey will be distributed to providers in the emergency department, and results will be analyzed to support further implementation efforts. Preliminary inquiry into providers’ usage of naloxone prescriptions and/or take-home kits for patients considered high-risk for opioid abuse will also be included in the survey. There were 61 survey responses. Attending physicians, resident physicians, and advanced practice clinicians (APCs) comprised 43%, 49%, and 18% of total responses, respectively. Overall, 45% of responders utilized the prescribing policy in their practice, while 55% had little to no awareness of the policy. 49% of participants stated that the policy has changed their prescribing practice, and 23% had referred to the policy within the last 30 days. A majority of responders (85%) felt a patient educational handout would help to communicate the risk of opioids with their patients, and 25% of participants had given naloxone prescriptions and/or take-home kits within the last 30 days.  Problem Statement The aim of this study is to assess providers’ (i.e., attending physicians, resident physicians, and advanced practice clinicians) awareness and perception of the opioid and controlled substance prescribing policy in the emergency department via an online survey. Conclusions and Future Implications The first phase of implementation exceeded expectations, with the policy impacting approximately half of providers. However, there is significant room for improvement, especially with respect to direct referral and overall awareness of the policy. The majority of providers view an educational handout favorably, which supports future adoption of such a handout, while a minority of practitioners have made use of naloxone prescriptions and/or take-home kits. This study should be repeated after further education of the policy is conducted in order to assess for increased adoption and utilization, as well as to monitor use of naloxone prescriptions/kits in the emergency setting. Opioid	  and	  Controlled	  Substance	  Prescribing	  Policy	  -­‐	  Questionnaire	  	  What	  is	  your	  licensure?	  •   Attending	  Physician	  •   Resident	  Physician	  •   Advanced	  Practice	  Clinician	  (APC)	  How	  many	  years	  have	  you	  been	  in	  practice	  in	  the	  ED?	  •   Less	  than	  3	  years	  •   3	  –	  10	  years	  •   More	  than	  10	  years	  Are	  you	  aware	  of	  the	  LVHN	  DOEHM	  opioid	  and	  controlled	  substance	  prescribing	  policy	  for	  ED	  providers?	  •   What	  policy?	  •   I	  have	  heard	  of	  it	  •   I	  use	  it	  occasionally	  •   It	  plays	  a	  significant	  role	  in	  my	  practice	  Has	  the	  implementation	  of	  the	  opioid	  and	  controlled	  substance	  prescribing	  policy	  changed	  your	  prescribing	  practice?	  •   Yes	  •   No	  In	  the	  last	  30	  days	  have	  you	  referred	  to	  the	  opioid	  and	  controlled	  substance	  prescribing	  policy?	  •   Yes	  •   No	  Would	  an	  educational	  handout	  help	  your	  ability	  to	  communicate	  with	  patients	  at	  risk	  for	  opioid	  abuse?	  •   Yes	  	  •   No	  	  In	  the	  past	  30	  days,	  have	  you	  prescribed	  naloxone	  or	  given	  a	  take-­‐home	  naloxone	  kit	  to	  a	  patient	  you’ve	  identified	  as	  being	  at	  high	  risk	  for	  opioid	  overdose?	  •   Yes	  	  •   No	  If	  yes,	  how	  many	  times?	  •   0	  –	  5	  •   6	  –	  10	  	  •   >	  10	  	  	  Please	  add	  any	  additional	  comments	  on	  the	  opioid	  and	  controlled	  substance	  prescribing	  policy	  below:	  _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	  	  Please	  add	  any	  additional	  comments	  on	  take-­‐home	  naloxone	  prescriptions	  or	  kits	  below:	  ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	  	  Opioid and Controlled Substance Prescribing Policy - QuestionnaireOpioid and Controlled Substance Prescribing PolicyLEHIGH VALLEY HOSPITAL LEHIGH VALLEY HOSPITAL – MUHLENBERG Department of Emergency and Hospital Medicine Division of Emergency Medicine Policy  Prescribing Opioid Pain Medication and Controlled Substances  in the Emergency Department   I. POLICY The overuse of opioid pain medications for the past 20 years has contributed to the current opioid addiction crisis in the United States and our communities. Addiction to opioid pain relievers has been fueling a massive rise in heroin use over the past several years. Opioid addiction is a significant public health threat in our local communities resulting in an increasing number of heroin and opioid overdose deaths. The staggering increase in heroin use has been strongly linked to prescription pain medication, with over 80% of heroin users reporting they started using heroin after becoming addicted to opioid pain relievers first. The emergency physician is required by law to evaluate an ED patient who reports pain. But this same law allows the emergency physician to use their clinical judgment when treating pain and does not require the use of opioids. This opioid prescribing policy is in accordance with current CDC and PA ACEP published guidelines.   Additionally, this policy is in alignment with the Emergency Department opioid stewardship and other Network-wide initiatives in both the ambulatory and inpatient setting designed to reduce undesirable practice variation and increase patient safety.   II. SCOPE This policy pertains to emergency medicine providers (physicians and APC’s) delivering care to patients in the Emergency Departments at LVH-Cedar Crest, LVH-Muhlenberg,  LVH-17th Street  and Hazleton sites.   III. PROCEDURE/GUIDELINE 1. The patient should not receive opioid prescriptions for chronic or recurrent pain from multiple providers. 2. Emergency medical providers will not provide replacement prescriptions for controlled substances that were lost, destroyed or stolen.  3. Emergency providers will not provide replacement doses of methadone for patients in a methadone treatment program.  4. Emergency providers will not prescribe long acting or extended release opioid agents such as OxyContin®, fentanyl patches, extended-release morphine, or methadone, unless coordinated with the outpatient provider. 5. The use of intravenous opioids in the ED for the relief of acute exacerbations of chronic pain is discouraged.   6. Due to unpredictable pharmacokinetics, the use of intramuscular opioids is strongly discouraged.  7. In compliance with state law, providers will query the PA PDMP prior to prescribing controlled substances or when substance misuse is suspected. When the PA PDMP is queried, provider shall document use of the database in the patient’s electronic medical record and provide a description of the decision to prescribe or deny.  8. When opioid use disorder is suspected or confirmed, the provider should encourage the patient to seek detoxification assistance. The emergency department staff should provide information to assist in this process.  Survey was drafted independently based on the goal of assessing providers’ awareness and perception of the policy in both quantitative and descriptive fashions. This involved creating closed-ended questions (e.g., Are you aware of the policy?) and open-ended questions (e.g., Please comment on the policy below). The draft was reviewed by several peers to evaluate the questions for accuracy and validity. The final draft was sent to emergency department leadership for feedback, and a revised version was emailed to all emergency department providers. Results were collected over a 30-day period. Are You Aware of the LVHN DOEHM Opioid and Controlled Substance Prescribing Policy for ED Providers?It plays a significant role in my practiceI use it occasionallyI have heard of itWhat policy?0 0.05 0.1 0.15 0.2 0.25 0.3 0.40.35 0.45What policy? I have heard of it I use it occasionally It plays a significant role in my practice16.67% 38.33% 11.67% 33.33%Lehigh Valley Health Network, Allentown, PAMultifactorial Approach to Opioid Abuse Within the Emergency DepartmentAlec Freling, MS4 and Robert D. Cannon, DO

Multifactorial Approach to Opioid Abuse Within the Emergency Department

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1209&context=select-program

Multifactorial Approach to Opioid Abuse Within the Emergency Department

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works