Transcript Improving Pain Control and Reducing Opioid Related Adverse Events

Improving Pain Control and
Reducing Opioid Related Adverse
Events
Adam Novak
Manager, Patient Safety & Quality
Michigan Health & Hospital Association Keystone Center
February 7, 2017
Objectives
• Describe the MHA Keystone Center Pain
Management activities and tools involved in reducing
opioid-related adverse events
• Discuss the impact of MHA Keystone Center Pain
Management Activities
MHA Keystone Center: Our Mission
Vision
Healthcare that is safe, effective, efficient, patient-centric, timely
and equitable.
Mission
To lead the nation in quality and patient safety through the
diffusion of change using patient-centered, evidence-based
interventions supported by cultural improvement.
Values
Excellence • Innovation • Compassion • Teamwork
Opioid Crisis - Background
Opioid Crisis – Additional Statistics
•
69% of people who misuse pain medication got them from a friend or relative
•
80% of heroin users began by misusing pain medication ordered by their doctors
•
Drug overdose is the leading cause of accidental death in the United States
o
More than car accidents
Opioid Crisis – In Our Backyard
MHA Keystone’s Timeline for Opioid Adverse Drug Events and
Pain Management
2013-2014
2015 – Sept. 2016
Sept. 2016 – Sept. 2019
•MHA Keystone Surgery
•IV Opioids Only
•Surgical Population (Inpatient &
Outpatient)
•Exclusion: OB
•29 hospitals submitting data
•MHA Keystone Pain Management
•IV Opioids Only
• Inpatients, surgical outpatients
•Exclusion: OB and ED
•215 hospitals submitting data
•Targeted Improvement
•Opioids (All Routes)
•Inpatients, surgical outpatients
•Exclusion: OB and ED
•300+ hospitals submitting data
Methods/Timeline of Activities – HEN 1.0 and HEN 2.0
CMS PfP Hospital
Engagement
Network (HEN)
Advisory
Committee
• Opioids called out as high-risk medication needing to be addressed
• Coupled with MHA Keystone: Surgery efforts around Enhanced Recovery After Surgery (ERAS)
• Obtained a physician champion for MHA Keystone
• Convened an advisory committee comprised of an anesthesiologist, director of surgical services,
independent nurse consultant, Michigan Surgical Quality Collaborative (MSQC) abstractor, pain nurse
resource specialist, pharmacist, surgeon, and surgical nurses
• Conducted gap analysis
Gap Analysis
Roll Out
• Project launch meeting was held
• Educational materials were distributed including the Michigan Opioid Safety Score (MOSS) tool, sample
order sets, data dictionaries, and schedule of monthly content webinars and coaching calls
• Expanded from surgical to inpatient and surgical inpatient and outpatient under HEN 2.0
Procedure
Intervention 1: CUSP
• The Comprehensive Unit-based Safety Project (CUSP) follows a six step iterative
program to improve patient safety and the culture that drives safety attitudes
and practices.
Intervention 2: Educational program including in-person and multi-media sessions
• Monthly content webinars, monthly coaching calls (in collaboration with the
Armstrong Institute for Patient Safety & Quality, Johns Hopkins University), and
an annual conference (in person meeting) with national speakers.
Intervention 3: Implementation of a perioperative pain management toolkit
• Gap Analysis tool, Michigan Opioid Safety Score (MOSS tool), patient and family
education templates, pre-op checklist modification recommendations, and a
multimodal analgesia tool (with specific recommendations for order sets).
Opioid Adverse Drug Event Prevention Gap Analysis
Pain Management Gap Analysis Results 2014
There is a process in place to discuss and agree
upon specific pain goals and strategies with the
patient prior to a surgical procedure.
Collecting a history of snoring, obesity and sleep
apnea
Defining and identifying if patient is opioid tolerant
vs. opioid naïve
Reversal protocols are active on all patients' MARS
if there is an active order for a narcotic
Established dose equivalency conversion tools are
readily availale and utilized
0
Yes
No
5
10
15
20
25
Michigan Opioid Safety Score (MOSS)
Goals
• Incorporate patient/procedural risk
factors
• Incorporate respiratory rate
• Incorporate sedation
• Reinforce need for multimodal
analgesia
• Improve nursing documentation of
patient assessment
Soto, Roy; Yaldou, Brandon. The Michigan Opioid Safety
Score (MOSS): A Patient Safety and Nurse Empowerment
Tool. Journal of Perianesthesia Nursing 2015, June, 30(3)
196-200.
MOSS Continued…
MOSS Continued…
Results – 2014 (Surgical)
Percent of patients who received naloxone during
surgical related care
0.50%
Percent of surgical patients receiving MOSS
assessments
60%
0.45%
0.40%
0.35%
50%
40%
0.30%
0.25%
30%
0.20%
0.15%
0.10%
20%
10%
0.05%
0.00%
n = 24
0%
MHA Keystone: Pain Management Collaborative
•
•
•
•
•
Launched in 2015
Improve appropriate pain management practices
Reduce opioid-related adverse events
Decrease the usage of opiates statewide
Enhance patient expectation management
Focused Interventions
1. All patients will be screened to determine if they are opioid naïve or opioid tolerant prior to receiving
any opioids.
2. All patients needing pain control will have multimodal analgesia. Providers will follow the World
Health Organization (WHO) analgesic pain ladder when prescribing.
3. All patients receiving opioids will be formally assessed via the Michigan Opioid Safety Score (MOSS)
or Pasero Opioid-induced Sedation Scale (POSS) on a regular basis to prevent unintended sedation and
respiratory depression.
4. Patients receiving opioids will not receive more than one concomitant sedative.
5. All patients receiving pain medications will be counseled on the medication they are receiving, any
potential side effects and expectations of realistic pain management.
6. Policies and procedures will be established for patients who are no longer responding to treatment,
directing that those patients receive increased monitoring, level of care, and appropriate pain
consultation.
7. Patients requiring a PCA will be monitored via pulse oximetry and/or capnography.
Pain Management Toolkit
Comparing 2014 to 2015 Gap Analyses
Expectation Management
Results – 2015-2016 Inpatient and Surgical Patients
26
Additional Programs/Tools
MHA Keystone Speak-up! Award
The MHA Keystone Center Speak-up! Award is designed to acknowledge the
efforts of individuals or teams within Michigan hospitals who speak-up to prevent
potential harm to patients or other staff members.
• 182 nominees
• 19 hospitals
• 55% of nominees who spoke up
to prevent harm, prevented or
mitigated an ADE
29
10 Things Every Patient in Pain Should Know
• 10 day social media
campaign
• 1 hour Twitter chat
• 1.5 million impressions
Medication Disposal
Endorsing and Supporting Organizations
The Future of Keystone and Opioids
2013-2014
2013-2014
2015 – Sept. 2016
•MHA Keystone Surgery
•MHA Keystone Pain Management
• MHA Keystone Surgery
•IV Opioids Only • IV Opioids Only
•IV Opioids Only
• Surgical Population (Inpatient
•Surgical Population&(Inpatient
• Inpatients, surgical outpatients
Outpatient) &
• Exclusion: OB
Outpatient)
•Exclusion: OB and ED
• 29 hospitals submitting data
•Exclusion: OB
•215 hospitals submitting data
•29 hospitals submitting data
Sept. 2016 – Sept. 2019
•Targeted Improvement
•Opioids (All Routes)
•Inpatients, surgical outpatients
•Exclusion: OB and ED
•300+ hospitals submitting data
Leading Healthcare
Safe Care is what drives us.
Collaboration is how we get there.
Thank you!
Adam Novak, MA | Manager, Patient Safety & Quality
MHA Keystone Center
2112 University Park Drive | Okemos, MI 48864
(517) 886-8257 | (517) 323-0946 Fax
[email protected]| www.mhakeystonecenter.org