7/6/2018 1 Saving & Changing Lives: Ochsner’s Opioid Stewardship Program What Sparked our Interest – How common opioid dependency was becoming – How worrisome the morbidity and mortality in becoming in patient populations – How disruptive Opiod patients were in the hospital (contributing to burn-out of providers and nurses, as well as therapeutic uncertainty)
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Saving & Changing Lives: Ochsner’s Opioid Stewardship Program · Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2017 y x Opioid Prescribing
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7/6/2018
1
Saving & Changing Lives:
Ochsner’s Opioid
Stewardship Program
What Sparked our Interest
– How common opioid dependency was becoming
– How worrisome the morbidity and mortality in becoming in
patient populations
– How disruptive Opiod patients were in the hospital (contributing
to burn-out of providers and nurses, as well as therapeutic
uncertainty)
7/6/2018
2
Starting Out
• As we began our work, our approach was
– 1. Preventing Opioid Dependency
– 2. Treating It
• It became clear we needed a small army
– As we began to recruit participants, we found a plethora of
professionals who were extremely engaged with the issues
themselves, and our ability to make a difference
Building the Right Team • Identified Executive Sponsor: Chief Quality Officer
• Allocated Resources: Project Management Support
• Initial Goal to Change Provider Behavior
– Enlisted Provider Participants: Representatives from Each Campus
Who Expressed Interest
• Supplemented Team with Pharmacy, Nursing, Legal, Compliance
and Security
• Initially Identified 3 Components for Project Strategy:
– Education for MDs and Patients
– Data Transparency, Practice Improvement, Patient Resources
– Subsequent Work Groups Developed
7/6/2018
3
Team Lead
Hospital Opioid Stewardship
Strategic Program Manager
Clinic Opioid Stewardship
Opioid Stewardship
Opioid
Management
ED Opioid Stewardship Dependency Treatment
and Recovery
Pain Treatment
Opioid Stewardship Org Structure
Support Diversions
Our First Big Win: ED Data Transparency
• Provided Blinded, and Eventually Un-Blinded, Data to Each
ED Leadership Team:
– Prescription Volumes and Rates by Provider and Unit
– The Average Prescription Morphine Equivalent (MEQ) of Each
Provider- Converted More Than 200 Opioids to Normalize the Potency
Across Different Drugs
– Information on What Drugs Each Provider and Unit Were Prescribing
• Also: – Established Guidelines and defaulted quantities in Epic prescribing function
7/6/2018
4
Initial Resistance: HCAHPS Physicians Who Prescribe Less Have
Same Patient Experience
70
75
80
85
90
95
100
0% 5% 10% 15% 20% 25% 30% 35% 40%
Pat
ien
t Ex
per
ien
ce M
ean
Sco
re
Opioid Prescribing Rate
Opioid Prescribing Rate vs. Press Ganey Mean Score by Physician
To Ease Fears, Removed Patient Satisfaction for Pain Despite
Lack of Correlation
Setting Expectations for Our Patients
7/6/2018
5
2,500
3,000
3,500
4,000
4,500
5,000
5,500
6,000
90.00
100.00
110.00
120.00
130.00
140.00
150.00
160.00
170.00
180.00
190.00
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2017
To
tal R
x
Rx
/Da
y
Opioid Prescribing in the ED
Rx/Day Total Rx
ED Opioid Prescriptions
Blinded
Data
Began
Un-blinded
Data
75.00
80.00
85.00
90.00
95.00
100.00
105.00
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec