PENNSYLVANIA OPIOID SURGICAL STEWARDSHIP ENTERPRISE
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1 PENNSYLVANIA OPIOID SURGICAL STEWARDSHIP ENTERPRISE Henry A. Pitt, M.D. Chief Quality Officer, Temple Health Matthew Philp, M.D. Surgeon Champion, Temple Univ Hospital Pennsylvania NSQIP Consortium January 17, 2019
2 OVERVIEW Collaboration PANC Procedures Steering Committee PANC Guidelines Year-1 Timeline PANC Measurement PANC Hospitals Next Steps
3 COLLABORATION HCIF ISMP PANC Dept of Public Health Amerisource Bergen ISQIC
4 STEERING COMMITTEE Executive Champion Henry A. Pitt, M.D. Temple University Health System Surgeon Champion Matt Philp, M.D. Temple University Hospital PANC Surgeon Advisor Scott Cowan, M.D. Thomas Jefferson University Hospital Surg Clinical Reviewer Christine Schleider, RN Thomas Jefferson University Hospital HCIF Team Pam Braun, Susan Cosgrove, and Kelsey Salazar Non-Panc Surgeon Advisor Patrick Ross, M.D. Main Line Health, Lankenau
5 TIMELINE YEAR 1* Q1 - Planning meetings Q3 - Share survey results - PANC meeting #1 - PANC meeting #2 - Measure development - Pt edu materials - Survey development - Shared workspace Q2 - Webinar #1 Q4 - PFAC meetings - Hospital enrollment - Pt edu materials - Administer survey - Webinar #2 - Finalize measures - Begin data collection - Form PFAC *September 1, 2018 August 31, 2019
6 PANC HOSPITALS Abington Jefferson Health* Fox Chase Cancer Center* Hahnemann University Hosp Hosp University of PA* Lancaster General Health* Pennsylvania Hospital* Reading Hospital Robert Packer Hospital Temple Health Jeanes* Temple Univ Hospital* Methodist Jefferson Health* Thomas Jefferson Univ Hosp* Penn State Hershey MC York Hospital *Also Health Care Improvement Foundation (HCIF)
7 PANC PROCEDURES General Orthopedics - Appendectomy - Total knee - Cholecystectomy - Total hip - Colectomy Neurosurgery - Hiatal hernia - Spine - Inguinal hernia Urology - Ventral hernia - Nephrectomy Vascular Surg Gynecology - Aortoiliac - Hysterectomy - Peripheal
8 PHILADELPHIA GUIDELINES Procedure # Pills* Appendectomy Cholecystectomy MIS 0 Colectomy MIS 6 Open 6 Hiatal Hernia Inguinal Hernia Ventral Hernia *Oxycodone 5 mg or Hydromorphone 2 mg =No Reccomendation
9 PHILADELPHIA GUIDELINES Procedure Hysterectomy # Pills* Total knee 9 Total hip 9 Spine Nephrectomy Aortoiliac 9 Peripheral vascular =No Recomendation
10 PANC GUIDELINES Procedure # Pills* Appendectomy Cholecystectomy Colectomy Hiatal Hernia Inguinal Hernia Ventral Hernia MIS Open MIS Open MIS Open MIS Open MIS Open MIS Open *Oxycodone 5 mg or Hydromorphone 2 mg
11 PANC GUIDELINES Procedure Hysterectomy MIS Open # Pills* 20 Total hip 20 Total knee 20 Spine 20 Nephrectomy MIS Open 20 Aortoiliac Endo Open 20 Peripheral vasc Endo Open 20
12 PANC MEASUREMENT Principle procedure CPT Code Primary surgeon Opioid use screen preop Fibromyalgia, chronic pain, substance use State database 3 months preoperatively Opioid avoidance Epidural, blocks Alternate medications
13 PANC MEASUREMENT Opioid discharge prescription Type, strength, number, frequency Active benzodiazepine prescription Opioid use postoperatively State database 30 days postop Routine NSQIP outcomes
14 NEXT STEPS PANC Sign agreements Administer surveys Finalize plans Non-PANC Introductory letters Sign agreements HCIF Surgeon surveys Webinar #1 Form PFAC
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