Power Session: Tackling the Opioid Crisis
Leigh Anne Bakel, MD, Assistant Professor of Pediatrics and Pediatric Hospital Medicine, Children's Hospital Colorado
Harnessing the EHR to Reduce Unnecessary Opioid Exposure in Children
Session recording available below
Summary: An institutional initiative and intervention driven by a multidisciplinary task force at Rady Children’s Hospital – San Diego aimed to reduce unnecessary pediatric exposure to opioid medications. In partnership with patient input, the hospital made important clinical practice changes that produced measurable results within five months.
Description: Recent data highlights morbidity and adverse outcomes from pediatric opioid exposure and the contributory role of clinicians and their prescribing of opioids to the development of opioid misuse in adolescence and adulthood. Rady Children’s Hospital San Diego examined opioid prescription practices at their institution and found room for improvement. Staff launched an electronic health record intervention targeting outpatient opioid prescriptions and have demonstrated notable improvements in reducing amount and duration of opioid prescriptions in both medical and surgical subspecialties.
- Use data to drive change, particularly to reduce unnecessary pediatric opioid exposure.
- Leverage EHR to standardize safe prescription of opioids for acute pediatric pain management.
Stop at Seven: Reducing Unintended Variation in Discharge Opioid Prescribing
Summary: In response to the opioid epidemic, Children’s Hospital Colorado developed a clinical pathway and designed interventions to reduce unintended variation in discharge opioid prescribing practices for patients with acute pain. Through these interventions, the team increased orthopedic surgery providers’ compliance with discharge prescribing recommendations from 57 percent to 86 percent.
Description: Prescribing practices are a key driver of the opioid epidemic in the U.S., and there is a paucity of research to guide pediatric prescribing. Children’s Hospital Colorado developed a new clinical pathway to reduce unnecessary variation in opioid prescribing. The team designed a measurement system, queried baseline data, conducted chart reviews, and garnered local expert consensus to inform a recommendation to limit discharge opioid prescriptions to a seven day supply for hospitalized non-cancer, non-ICU patients with acute pain. Subsequently, the team partnered with orthopedic surgery to design and test interventions to increase compliance with the discharge prescribing recommendations.
- Describe an approach to determining pediatric-specific recommendations for discharge opioid prescribing for acute pain.
- Discuss process improvement activities that improved compliance with discharge opioid prescribing recommendations without increase.
Highlights from this session:
- EHR changes including prescribing module promoting CDC guidelines, order set with scheduled dosing, best practice advisory and e-prescribing of controlled substances
- Organizing provider education