Conn. ED Cuts Opioid Prescriptions in Half With New Treatment Initiative
The Hour, Norwalk, Conn.
June 09—When doctors in the Norwalk Hospital Emergency Department pull up their electronic care plan system on a computer, next to the most common patient ailments is a new option: "non-opiate."
When the option is clicked, the system lists alternatives to opiate-based treatments. It's part of the hospital's recent opioid initiative aimed reducing the amount of opiates the emergency department orders for use in-house. In the past two years, it succeeded dramatically -- the amount of opiates the department ordered nearly halved, dropping by 46 percent.
Benjamin Greenblatt, chairman of the emergency department, said the initiative was the department's response to the opioid pandemic.
"You can't ignore it, right?" he said. "It's in the newspapers, it's in the news, it's in the literature -- whether in the throwaway magazines or the peer-reviewed journals. It is just everywhere."
However, when one of the department's physicians, Chris Michos, began advocating for an opioid initiative, Greenblatt was unsure how much the department could reduce its opiate ordering. It had been years since the staff had learned about the dangers of opiates.
"Had we already changed our ordering habits?" he asked.
When the data came in this January, two years after the initiative began, it became clear that the new measures had made a significant impact. "The number was a lot bigger than we ever thought it was going to be," Greenblatt said of the drop.
In addition to changing the electronic care plan system, the department invited guest speakers and educated staff on the latest research and practices. Michos visited St. Joseph's Healthcare System, which hasNew Jersey's busiest emergency department, to learn best practices after it also launched an alternatives to opiates program (St. Joseph's reported a 58 percent drop in opioid prescriptions within a year).
The goal, staff said, was not to eliminate opiate orders but to reduce unnecessary use.
"With Dr. Greenblatt's support, a collaborative team including myself, nursing and pharmacy met to include evidence-based new treatments and to utilize standard medications that, based on new research, was as effective as opioid medication without the side effects and risk of addiction," Michos said.
Continued education is important because medical consensus shifts over time.
"When I trained, if someone had a lot of pain, it was Percocet, Valium," Greenblatt said (both are narcotics). In the intervening years, studies showed that Tylenol and Motrine can work together to be as effective as a Percocet and could be combined with other non-opiate treatments, such as muscle relaxers, steroids and heating pads.
"From our point of view, it's a much safer way of doing things," Greenblatt said. He pointed out that the initiative was also a very low-cost way of reducing opiate orders. "So the idea would really be to scale it up through the network."
Katherine Michael, a psychiatrist and medical director of community health at the Western Connecticut Health Network, of which Norwalk Hospital is part, said Norwalk Hospital's opiate initiative fits in with other ways the network addresses the opioid pandemic. For example, the network looks for flags that patients may have substance-abuse problems and pairs such patients with specialists who have worked through similar issued themselves. "Essentially the way I think about it is we're trying to bring treatment of this problem into everything that we do," Michael said.
As Greenblatt left his office, Brian McGovern, an attending emergency department physician, came up and began quietly updating him on a patient who had come in that day. The patient was aching from a virus, and his family had requested narcotics to ease the discomfort.
"A lot of the time, people come here for us to take care of their pain," he said. "And you have to be careful about how you do that."
McGovern said he had pointed the family to a host of alternatives with lesser potential side effects than a narcotic and explained that the recent initiative had made it easier for him to do so. "I feel now I have a backing to say no."