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Rightsizing opioid utilization during labor and delivery: 3 imperatives from a Centura hospital

January 8, 2019

    Opioids can be an effective treatment to reduce pain associated with labor and delivery, especially for the more than 2.5 million women who give birth vaginally each year. However, in light of the nationwide opioid crisis and the role that overprescribing has played in the proliferation of opioid abuse and addiction, hospital and health system leaders are expanding their efforts to rein in unwarranted opioid utilization.

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    Castle Rock Adventist Hospital in Castle Rock, Colorado, (part of 17-hospital Centura Health) has reduced the amount of opioids—including the number of patients receiving opioids, the dosage level per patient, and the number of pills per patient—given to patients for vaginal deliveries by 50 percent in six months as a result of a collaborative new initiative that brings together pharmacy, nursing, and quality leaders. We sat down with Andrew French, Castle Rock's CMO, to discuss the initiative and learn what drove their success. Three key imperatives emerged during our conversation:

    1. Retrospectively review patient records to uncover discrepancies between reported levels of pain and subsequent opioid utilization

    This initiative began when Castle Rock's pharmacy director noticed discrepancies between patients' reported pain levels and subsequent opioid utilization. The hospital followed up by assigning a quality officer to review medication records and notes in the EHR. Upon retroactively examining patient records, the quality officer discovered the department was over-utilizing opioids relative to patients' reported levels of pain. For example, patients who reported only "moderate" pain were receiving an amount of opioids clinically appropriate for "severe" pain.

    2. Showcase data to generate buy-in and engage frontline staff in combating opioid overutilization

    After uncovering this source of inappropriate opioid utilization, hospital executives shared the data with nurse leaders, who presented it to frontline staff at daily huddles to raise awareness of the issue. Presented with reliable data and a clear problem, nurses were able to quickly adapt their behavior and rapidly reduce opioid overutilization. Perhaps even more impressively, they have been able to maintain that reduction in the months following the intervention.

    3. Set the right patient expectations for pain management through comprehensive pre-natal education

    In addition to Castle Rock's work to engage frontline staff in rightsizing opioid utilization, the hospital also expanded its existing pre-natal education program for expecting mothers in the community. The more comprehensive curriculum now includes education focused on setting realistic expectations for pain management and appropriate opioid utilization during labor and delivery.

    By focusing on a single service line and engaging both frontline staff and patients, Castle Rock has made substantial progress in reducing unwarranted opioid use. Going forward, hospital leaders believe improved data analytics and reporting—such as generating an automated report on the relationship between pain scale and medication use—will play a significant role in rightsizing opioid utilization across the organization.

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