Though there is more of a focus on reducing the overuse of opioids for pain management, hospitals still see adverse events involving accidental overdose on these painkillers—but there are several steps providers can take to reduce patient harm related to opioid medications, according to a new report.
ECRI Institute Patient Safety Organization analyzed more than 7,200 adverse events caused by opioids that were reported voluntarily. More than half of events were linked to either medication administration errors (35%) or drug diversion (28%).
Issues linked to prescribing and patient monitoring were reported less frequently, but were more likely to cause patient harm, according to the report. Patient harm was reported in 1 in 5 cases that noted a level of harm.
"While opioids play a useful role in treating pain, the risks that come with them require that safeguards be put in place to stop misuse or overuse," Bill Marella, executive director of PSO operations and analytics at ECRI, said in an announcement. "The good news is that there are many realistic opportunities to improve the safety of opioid use in hospitals."
ECRI's report offered a number of ways that hospitals can reduce patient harm tied to opioids, including:
- Create an interdisciplinary team to improve pain management and target opioid safety: A team to lead the charge on pain management and safety can assess current practices, develop new ones and monitor performance.
- Get leadership buy-in on opioid safety: For any initiative to be effective, leadership must support the goals and frontline staff must be engaged on the issue, according to ECRI.
- Asses formulary practices and apply clinical decision support to standardize the approach: ECRI's analysis found a mix of human and technological errors that caused opioid-related patient harm, so it's key for care to be standardized appropriately while allowing for choices that fit each patient's individual needs.
- Educate staff on the risks related to opioids and safe use procedures: ECRI found that "knowledge deficit" was the third most-common contributing factor to opioid-related harm, so providers should identify and remedy gaps in knowledge for both clinical and non-clinical staff.
- Offer individual feedback to certain clinicians and units as needed: The patient management team can flag units or clinicians who may need individual reports on their prescribing habits, for example.
Hospitals are finding success in programs aimed at curbing opioid prescriptions and reducing the risk of harm. Bon Secours Health System's St. Mary's Hospital in Richmond, Virginia, for example, has cut post-operative opioid use, thanks to a new surgical program, the Richmond Times-Dispatch reports.
The hospital launched its St. Mary's Enhanced Recovery Program in August 2016, which changed the protocols for patients who are undergoing open or laparoscopic colorectal surgery. Patients are allowed to drink clear liquids up to two hours before surgery, are encouraged to load up on carbohydrates prior to the procedure and are given minimal IV fluids and few narcotic painkillers after surgery, according to the article.
The 100 patients who have participated in the program thus far saw an 80% reduction in post-operative opioid use, according to the article.