Duke has taken a broad approach to opioid safety. This has included developing guidelines and tools. The next step involves reaching out to our clinicians.
Collaborator (Non-Members)Michael Decoske
Opioid abuse is endemic in many communities in our state though we see less in the urban counties than in the rural counties. However, we manage many patients with acute and chronic pain on a daily basis.
Far more patients are being prescribed opioid therapy for chronic, nonmalignant pain. With this increase, there has been a commensurate increase in the numbers of the individuals developing opioid addiction, misuse and accidental opioid overdose. In addition, there are far too few pain specialists to effectively manage our burgeoning population with chronic pain who have become dependent on opioids as part of their management strategies. Clinicians of all types need to be able to manage this population with attention to safety and improving clinical outcomes.
Clinicians are aware that the number of individuals experiencing serious toxicity or overdose death from opioids has skyrocketed in recent years. However, many active clinicians have not yet adopted best practices such as using prescription drug monitoring programs, asking patients to enter into agreements, using informed consent or monitoring for illicit drug use utilizing urine drug screens. Too often, individual clinicians believe that these problems occur in patients managed by others and feel that they are too busy to make these changes in their own clinical practice.
Location-Across several counties in central North Carolina.
Type- Nonprofit, academic health system providing primary care through quaternary care.
Number of Beds-
Duke University Hospital- 942
Duke Regional Hospital- 369
Duke Raleigh Hospital-189
Payer Mix- Very broad from medically indigent, large Medicaid and Medicare, and a substantial number of commercially insured patients. Overwhelmingly Fee-for-service (FFS), though changing fast.
Population served- All from premature birth to very elderly, wide variety of socio-economic and racial groups, though primarily Caucasian and African-American.
Duke is of the top-ranked hospitals and training centers in the nation and a top-tier research center as well. We have a decent basketball team.
What We Tried
We have assembled a task force with representation from many areas of the Duke Health System, including both inpatient and outpatient clinicians, physicians, pharmacists and advanced practice providers. We reviewed current standards of care within our state as set forth by the North Carolina Medical Board and strove to create simplified documentation strategies within our electronic medical record in order to facilitate adherence to these standards. We have also begun to promote the use of our state’s prescription drug monitoring program. We have sought endorsement from the various management and leadership committees within the health system and obtained input from patient groups as well.
We will begin rolling out our program in the winter of 2016 once we get final approval from our highest levels of leadership within the health system. Currently, awareness of the problem and our management strategies has been increasing. We anticipate measuring the use of the prescription drug monitoring program, informed consent documents, urine drug screens and risk assessment tools that we have developed for use within our health system. Data to be reported in the future.
We believe that it was fundamental to obtain input from various stakeholders and to ensure that our internal guidelines were entirely consistent with broader guidelines as well as the current practice standards that prescribers are legally held accountable to. It has been clear early in our development that one can anticipate resistance from busy clinicians. Therefore, strategies for sharing the workload for carefully managing patients on opioid therapy need to be developed.