Opioid Guardianship Project: Combating the Opioid Crisis Sarah Derr, PharmD Meg Nugent, MHA, RN Iowa Healthcare Collaborative

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2 Opioid Guardianship Project: Combating the Opioid Crisis Sarah Derr, PharmD Meg Nugent, MHA, RN Iowa Healthcare Collaborative

3 Objectives Summarize the current crisis at the national and Iowa state level. Discuss approaching the opioid crisis from a prevention side through the use of comfort resources. Review quality data and preliminary translational research results reflecting improvement in pain management, decrease in adverse events and the impact of the comfort scale on prescribing practices and patient evaluation of pain.

4 National Opioid Crisis

5 Opioid Timeline

6 Opioid Misuse and Abuse Statistics Drugs overdose is the leading cause of accidental death in the US surpassed motor vehicle and gun deaths Opioid addiction is driving the epidemic Prescription pain relievers QUADRUPLED from 1999 to 2010 In 2015 more than 15 MILLION people were using prescription drugs non-medically In 2015 ~5.1 MILLION people misused pain relievers In 2016 over 214 MILLION prescriptions were written for opioids 4 in 5 new heroin users started out misusing prescription pain killers CDC, National Institute on Drug Abuse, and Foundation for a Drug-Free World

7 Illegal Drug Deaths CDC 2017

8 Iowa Opioid Crisis

9 Opioid Crisis in Iowa From : 11% increase in Opioid-Related Hospitalizations Most common characteristics for patient hospitalizations for opioid-related reasons: Woman 65 years or older Metropolitan area Low income 2014 AHRQ Trends in Opioid-Related Hospitalizations Info-graphic 2013 CDC

10 Controlled Substances Dispensed in Iowa Board of Pharmacy Report

11 Prescribing Rates By County 2006 CDC

12 Prescribing Rates By County 2016 CDC

13 Drug Overdose Deaths in Iowa Iowa Substance Abuse Brief, Iowa Department of Public Health

14 Moving Upstream: Addressing the Opioid Crisis

15 Moving Upstream: Prevention & Intervention

16 The Three Pillars to Address the Opioid Crisis Upstream Prevention and Appropriate Prescribing Medication Assisted Treatment and Relapse Prevention Diversion Prevention and Medication Disposal

17 IHC Opioid Guardianship Project

18 Iowa Healthcare Collaborative Our Mission The Iowa Healthcare Collaborative facilitates exceptional healthcare quality and safety for Iowans. Our Vision An Iowa healthcare culture of continuous improvement in quality, safety, and value that provides the most effective and efficient care in the nation. Cornerstones Align and equip Iowa healthcare providers for continuous improvement. Promote responsible public reporting of healthcare information. Raise the standard of healthcare in Iowa.

19 Iowa Healthcare Collaborative Initiatives Hospital Improvement Innovation Network (HIIN) Transforming Clinical Practice Initiative (TCPi) State Innovation Model (SIM)

20 Compass HIIN Partnerships Iowa Healthcare Collaborative (IHC) South Dakota Association of Healthcare Organizations (SDAHO) 150 Hospitals Iowa South Dakota Illinois Comprised of approximately 80% Critical Access/Rural hospitals

21 Engaging Partners in Efforts Who? Hospital-based community leaders including, but not limited to: patients, families, communities, providers, pharmacists, quality professionals, nurses, clinics, long-term care providers, case managers, patient advocates, dentists, veterinaries, law enforcement, and emergency medical services

22 Cohort 1 Participants

23 Cohort 2 Participants

24 Benefits of Participating Reduce data collection burden Data analysis provided by the Iowa Healthcare Collaborative Multi-disciplinary evidence-based best practices and emerging new resources provided Participate in Comfort Research Study to show efficacy of comfort scale Recognition as a leader Redesign workflow for high reliability Partner with patients and families Educate clinicians with evidence-based practices Meet regulatory/accreditation requirements

25 Tools Available

26 Comfort Scale Hospital Logo Here

27 Comfort Menu

28 Treatment Plan

29 Person and Family Engagement Each tool engages the patient to think about their comfort level Allows the patient to choose what will increase comfort Provides an action plan when transitioning home Empowers the patient to ask questions

30 Community Resources

31 Metrics Adverse Drug Event Rate Opioid Therapy Treatment Plan Stat Naloxone Administration in the Inpatient Population Stat Naloxone Administration in the ED

32 Qualitative Data

33 % facilities utilizing alternative treatment for pain Physical Therapy/Occupational Therapy Other Music Therapy Massage Essential Oils Counseling Chriopractic Care Pre-Survey Post-Survey

34 % facilities providing patients discharged on opioids information on where to dispose of unused opioids Yes No Pre-Survey Post-Survey

35 % facilities providing education to the community about the safe and effective use of opioids Yes No Pre-Survey Post-Survey

36 % facilities aware of the percentage of patients that are discharged on opioids Yes No Pre-Survey Post-Survey

37 % facilities collaborating with other entities about opioids Clinic Long Term Care Behavioral Health Law Enforcement Emergency Medical Services Other Pre-Survey Post-Survey

38 % of providers registered for and using the Prescription Monitoring Program % 51-75% 26-50% 0-25% Unsure Pre-Survey Post-Survey

39 Clinician feedback on using the comfort scale with each patient On average, clinicians/ practitioners reported a decreased time per patient On average, clinicans/practitioners reported an increaed time per patient On average, clinicians/practitioners reported no change in time per patient

40 Quantitative Data

41 ED Naloxone Administration

42 Naloxone Administered Outside of the ED - Inpatient

43 Naloxone Usage in the Community Setting Prior to Admission

44 Opioid Therapy Treatment Plan

45 Questions? Sarah Derr, PharmD Meg Nugent, MHA, RN

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