New York, NY—October 23, 2017
In the midst of the growing opioid epidemic, a group of clinicians, researchers and administrators at Hospital for Special Surgery (HSS) have created a comprehensive program to address opioid misuse as it presents at HSS. Details of the hospital’s narcotics initiative and the medical evidence used to build the program were published in the November 2017 special edition of Anesthesia and Analgesia.
Orthopedic surgeons are the third-highest group of physician opioid prescribers nationwide, according to the researchers. Given that HSS is the busiest orthopedic hospital in the U.S., hospital leadership understood the unique challenge of keeping patients both safe and comfortable as they recover from orthopedic surgery while balancing increased oversight and scrutiny over opioid prescribing practices.
To determine what changes needed to be made to hospital-wide opioid prescribing practices, a hospital-wide Controlled Substances Task Force led by Pain Management Services director Seth Waldman, MD, and Bobby Stack, MS, developed and implemented a multi-pronged approach to safer and more scrupulous opioid practices.
While addiction and overdose are two commonly cited risks of opiate use, long-term use of the narcotic can lead to other threats such as tolerance and eventually, hyperalgesia, a condition that makes patients more sensitive to new pain stimuli, a factor for consideration when someone is undergoing any surgery. To address these issues and to ensure that patients receive the tailored care they need, the Task Force created a screening and evaluation process for surgeons to identify patients with complex pain needs before surgery.
"This preoperative evaluation for patients is now an expected part of our workflow. It is almost universally recognized that this evaluation is a necessary part of patient safety and results in patient optimization and better surgical outcomes," explained Dr. Waldman.
Prescribers now use procedure-specific opioid prescription guidelines developed by the Task Force. New guidelines were part of a multi-faceted approach to educate clinicians on opioid prescribing and the risks associated with opioid misuse. The Task Force also focused their efforts on educational initiatives for patients and the community at large.
"The use of opioids to provide pain relief to our inpatient and ambulatory patients remains a critical component of patient care and satisfaction at HSS," said Ms. Stack, senior director in the Department of Anesthesiology. "With that in mind, we are doing significantly more to educate our patients on how to use, store and dispose of their medications, and we are encouraging patients to speak with us about opioids."
As the epidemic continues, the Controlled Substances Task Force continues to spotlight the use of safe opioids. Ongoing education for both prescribers and patients are a pillar of the hospital’s ongoing efforts to identify and minimize patient risk and improve outcomes and safety.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.