TeamHealth partnered with Baptist Memorial Hospital on developing new pathways to reduce the use of opioids and related narcotics by 75% in the Emergency Department.
Facility: Baptist Memorial Hospital – Memphis, TN
TeamHealth Services: Emergency Medicine and Hospital Medicine
- 75% reduction in opioid use in the emergency department
- 35% increase in patient experience scores for pain management
- Hospital recognized with a national award for medication safety
“The opioid crisis touches individuals and families across the country and here in Memphis. I applaud TeamHealth for taking the initiative to develop a program that has dramatically reduced opioid exposure for patients in our emergency department.” -Dana Dye, CEO, Baptist Memorial Hospital – Memphis
In the busy emergency department (ED) at Baptist Memorial Hospital in Memphis, the TeamHealth facility medical director noticed a growing problem. As the opioid epidemic escalated across the country, there were increasing numbers of opioid-seeking patients in the Baptist Memorial ED. Knowing that Tennessee ranks in the top tier for opioid-related deaths, and that patients’ first introduction to opioids often occurs in the ED, the clinical team sought strategies for (1) better managing opioid-seeking patients and (2) overall reducing or avoiding the use of narcotics in the ED.
TeamHealth looked to the successful example of a Colorado hospital to design an alternative pathway for pain management. In partnership with the Baptist Memorial pharmacy department, nursing team and hospital administration, TeamHealth focused on prescribing patterns. A multi-modal pain therapy “opioid-light” order set was developed in the electronic medical record for five specific indications where evidence showed non-opioids to be effective. The order sets outlined alternatives to narcotics – either non-opioid medications or, where opioids were needed, a smaller dosage mixed with other drugs. Pharmacists educated providers and nurses on the opioid-light order set and the medications were made available through automated dispensing to increase accessibility.
To support physicians’ interactions with patients, TeamHealth provided scripting to guide conversations about opioid alternatives. To establish accountability within the medical team, TeamHealth made each physician’s opioid statistics available for their colleagues to see. The transparency prompted collaboration among physicians, who approached one another to learn or share best practices and improve the entire team’s performance. Pharmacists also conducted one-on-one meetings with high-usage providers to address barriers and provide recommendations.
Since the program’s launch, opioid use in the ED has been reduced by 75%. ED nurses report less time spent with opioid-seeking “frequent flyers” and an increase in positive patient comments. In fact, despite initial concerns about the impact of these guidelines on patient experience, the ED saw an increase in satisfaction in both overall scores and those related to pain. The facility medical director attributes the enhanced experience scores to better patient interactions, wherein clinicians are more prepared to discuss the dangers of opioids and the benefits of alternative medications. Patients believe physicians are truly trying to address their pain without putting them at risk for ongoing opioid dependence. The program’s success earned the ED team a 2018 American Society of Hospital Pharmacists Excellence in Medication Safety Award.
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