Care Transformation Center Blog

5 steps to rein in unwarranted opioid prescribing

by Rebecca Tyrrell and Colleen Keenan

Although recent evidence suggests that opioid prescribing volumes are on the decline, experts agree that nationally we are still vastly overprescribing and suffering the consequences. Every day, nearly 115 Americans die from an opioid overdose.

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While there are a number of strategies that hospitals and health systems should employ to confront the crisis, reining in unwarranted opioid prescribing is an essential first step. Provider organizations are uniquely positioned to change prescribing patterns, which in turn can prevent new cases of misuse by reducing the volume of opioids entering the community.

5 steps to curb unnecessary opioid prescribing

Hospitals and health systems should focus on five strategies to rightsize their opioid prescribing practices:

  1. Lay the foundation: Health systems should start by involving staff and physicians from throughout the organization in a coordinated effort—likely through a committee or task force. While it is common for individuals to enact prescribing changes on their own, their impact is inevitably limited unless those changes are elevated to a system-wide level. The Joint Commission has recognized this and now requires hospitals to designate a leader or leadership team responsible for opioid stewardship.

  2. Activate the clinical workforce: With a team in place to dictate the system's crisis response strategy, the next priority is to develop education and communication plans to engage hospital staff and clinicians in new initiatives. Three engagement strategies include strategically communicating the system-level committee's mission and vision; conducting widespread education on the epidemic, its impact, and contributing factors; and engaging clinicians in candid conversations around pain management expectations.

  3. Develop institutional standards: A key function of the system-level opioid stewardship committee is revising or instituting opioid prescribing standards. While most prescribers will understand the need for practice change, there will likely be concerns about adjusting long-standing prescribing patterns. Leaders should survey their prescribers to understand the areas of greatest need and develop standards for pain management
  4. Integrate new standards into practice: Once the committee has defined the prescribing standards, the next step is system-wide implementation. Leaders should seek to put a variety of supports in place to guide prescribers to the best possible medication for each patient and condition. These supports should be coupled with checks that make it difficult for prescribers to deviate from the care standard, reviews of outlier prescribing, and formal interventions for clinicians whose prescribing patterns fall outside of accepted norms.
  5. Offer intensive support for difficult cases: U.S. medical schools have historically provided minimal pain management training, despite the fact that more than 100 million American adults suffer from chronic pain. As a result, physicians are often under-prepared to manage complex pain. Health systems should put resources in place to help clinicians manage difficult cases and invest in specialized support structures to ensure that pain experts review the most complex cases.

Once health systems implement these strategies to rein in unwarranted opioid prescribing, they can invest in other efforts to stem the epidemic, such as preventing drug diversion among health care workers, reducing the opioid supply in the community by conducting drug take-back programs, or partnering with community-based organizations to connect patients to treatment resources.

 

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