Other efforts in the health system included alerts, education and clinical decision support which helped lower the number of opioid prescriptions given to patients.
As the opioid crisis negatively impacts lives across the United States, health systems continue to look for innovative ways to curb the epidemic. In Missouri in 2017, the state recorded 16.5 opioid-related deaths per 100,000 people, above the national average of 14.6 deaths.1 In addition, the state had a higher prescription rate of 71.8 opioid prescriptions per 100 people, compared to the nationwide average of 58.47.2 Working with Cerner, CoxHealth leaders at the ITWorksSM client began tackling the problem head-on, leading to a drop of nearly 20% of opioid prescriptions.
“We unfortunately see lives impacted every day,” said Tayo Bakare, PharmD, ALM, BCPS, director of pharmacy. “We didn’t want to just sit around and do nothing and wait for the federal and state governments to act. We wanted to act locally.”
CoxHealth leaders formed a stewardship committee and worked closely with Cerner’s Patient Safety and Quality teams to tackle the problem. The health system began utilizing the Cerner Opioid Toolkit which included alerts, as well as educating providers and utilizing clinical decision support.
The combination of those efforts helped drop opioid prescriptions 18% among orthopedic and family practices.3
“Just because the alert flags and tells me that this patient may be high risk doesn’t necessarily mean that I shouldn’t prescribe it,” said Louis Krenn, MD, medical director of ambulatory clinical practice efficiency. “It means I need to think twice about other medications that the patient may be on or provide additional safeguards to the patient.”
In addition, the toolkit helped standardize opioid treatment agreements. These documents ask patients to agree to certain conditions to help prevent addiction. The terms can include agreeing to random drug tests and other criteria. If a patient breaks the agreement, it can mean they won’t receive opioids from that provider any longer.
“Now, no matter what provider you’re seeing, you’re using the same opioid treatment agreement,” said Bakare. “Using the toolkit, we’re able to improve the capture of a patient’s opioid treatment agreement, then communicate that to other providers who might also look at prescribing opioids for that patient.”
From the organization’s February 2019 implementation through the end of the year, 40% of chronic opioid use patients agreed to an opioid treatment agreement. The agreements help increase communication between patients and their provider.
“With the deployment of the toolkit, it reminds the physician that it may be time to have a conversation with a patient about signing an opioid agreement,” said Bakare. “It may have been three months, but the patient has already received more than 90 days of opioid therapy. It allows that physician to have that conversation with a patient regarding the risks and discuss the risk benefits when they sign the agreement.”
CoxHealth leaders plan to continue exploring other ideas to help address the crisis.
“We’ve had to be quite creative in finding a way to support our physicians by making sure they actually know what’s going on with their patients,” said Bakare. “The Opioid Toolkit has been helpful with that.”
“I think we can continue to refine the toolkit,” said Krenn. “It definitely has been beneficial and we have no regrets of being one of the early adopters of it.”
For more on best practices with opioid management, visit our Model Experience website.
1 “Missouri Opioid Summary,” National Institute on Drug Abuse, March 2019, https://www.drugabuse.gov/opioid-summaries-by-state/missouri-opioid-summary
2 “U.S. State Prescribing Rates, 2017,” Centers for Disease Control and Prevention, accessed January 7, 2020, https://www.cdc.gov/drugoverdose/maps/rxstate2017.html
3 Comparing a total of 70,836 prescriptions from August 2018-January 2019 to 57,133 prescriptions from February 2019-July 2019.