Implementing an Opioid Risk Reduction Program in a Comprehensive Inpatient Rehabilitation Unit

From the 2018 HVPAA National Conference

Margaret Kott (Johns Hopkins Hospital), Stephanie Van (Johns Hopkins Hospital), Ada Yao (Johns Hopkins Hospital), Teresa Tang (Johns Hopkins Hospital), Alexis Coslick (Johns Hopkins Hospital), Nicholas Dabai (Johns Hopkins Hospital), Amira Noles (Johns Hopkins Hospital), Erik Hoyer (Johns Hopkins Hospital)

Background

The opioid epidemic is a worsening public health issue compounded by wide availability, improper disposal, and lack of patient education on risks of opioid medications. Opioid risk reduction programs utilizing naloxone have been successful in multiple healthcare settings, but not yet tested specifically in the comprehensive inpatient rehabilitation (CIR) setting.

Objectives

To implement an opioid risk reduction program in a CIR unit with the goal of reducing patients’ risk of an adverse drug event after discharge.

Methods

This prospective cohort QI study involved 788 patients admitted to a Johns Hopkins Hospital CIR unit. Baseline data on opioid and naloxone prescribing trends was collected from 7/1/2015 – 9/30/2015 (the pre-QI period). The opioid risk reduction program consisted of patient education on opioid overdose symptoms and intranasal naloxone administration, and prescription of intranasal naloxone to those requiring opioids on discharge. Following program implementation, data collected from 7/1/2016 – 11/31/2016 (the late QI period) was used in comparative statistical analyses. Main outcome measures were the proportion of patients discharged on opioids, the proportion of eligible patients who received a naloxone prescription upon discharge, and the proportion of patients who were originally admitted on opioids but then weaned off prior to discharge. Multivariable analysis was conducted using general estimating equations accounting for patient demographics, admission morphine equivalents, admission pain scores, and diagnoses.

Results

The intervention significantly decreased the proportion of patients discharged on opioids (pre-QI: 54%; late QI: 35%; p<0.001). The adjusted odds of patients weaned off opioids were 10 times higher (aOR 95% CI,4-25, p<0.001) during the late QI period compared to the pre-QI period. A significantly larger proportion of eligible patients received a naloxone prescription upon discharge after the intervention (pre-QI: 16%; late QI: 45%; p=0.004). Discharge pain scores between pre-QI and late QI periods did not change (p=0.28).

Conclusion

This opioid risk reduction program significantly decreased the proportion of patients discharged on opioids and increased the proportion of eligible patients receiving naloxone, without affecting discharge pain scores. We demonstrated this intervention can be successfully implemented in a CIR unit, thereby reducing the risk of opioid-related adverse events in this diverse patient population upon their return to the community.

Implications for the Patient

An opioid risk reduction program can encourage prudent opioid use in addition to increasing naloxone availability. This is particularly valuable and impactful in rehabilitation, where optimal pain management is vital to recovery. The CIR setting supports a multidisciplinary approach to patient safety, which is ideal for implementing such a program.

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