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.