This year, the winner of the HAP Achievement Award for “Excellence in Care” was honored for its programs that not only showed a commitment to patient care but its commitment to battling a national epidemic—the opioid crisis.
The OSS Orthopaedic Hospital took the win in the small organization category. It is a free-standing facility in York dedicated exclusively to orthopedic surgery. After seeing reports of the rising issue of opioid addiction and related deaths, OSS believed it was obligated to make a change for its community.
The entire health system committed to reducing the number of pills prescribed and the number of opioid prescriptions initiated to parallel only the duration of the acute, severely painful phase after a patient undergoes surgery. Because orthopedic surgeries are the focus at this facility, all of the health system’s patients were important targets for this program, leading OSS to implement a strategic, consistent focus on robust opioid-related patient education.
Leads for this initiative at OSS were Director of Pharmacy Meghan McNelly and Suzette Song, M.D. Vice President of Medical Affairs.
“When you gather many experts together to do the same orthopedic procedure, what you find is, unless you standardize the way you treat these procedures we do so frequently, you could have 30 different doctors treating patients who get the same procedure in completely different ways,” Dr. Song said.
Instead of waiting until the epidemic reached a point where new policies limited medication decisions for patients who were undergoing painful procedures and recovery, the OSS team realized the best idea was to standardize the distribution for each procedure to ensure patients weren’t in pain and weren’t left with excess pills that could get into the wrong hands.
“One of the things we recognized was that we had the advantage of pulling together many different experts on many different specific topics, and we had a small variation of procedures we perform at such high frequency, which meant we could experiment and make adjustments to find the safe medication distribution in a shorter amount of time,” Dr. Song said.
“This meant that we could get a head start on the data we were collecting and really make progress even before opioid-related deaths were in the news every day.”
OSS’s journey began in early 2016, when it started looking at the baseline data regarding prescriptions given in the last quarter of 2015. Although during this time frame OSS was recognized by Press Ganey for its high patient satisfaction scores, the team believed the number of opioid prescriptions written was alarmingly high.
“When the conversation regarding opioids really began to gain speed, we realized the conversations were mostly about death rate, rehab and treatment, and facilities not having enough beds,” Dr. Song said. “It seemed like most of it was centered around what to do after someone is addicted, and at OSS that’s not really our world. We can’t have an impact on that, but this we could.”
As of 2012, the majority (70 percent) of new or occasional abusers of prescription medication obtained drugs from a relative or friend without asking. Because of this staggering statistic, OSS realized the role it could play in this epidemic was making sure there weren’t extra prescription pills lying around to be stolen.
After the baseline for OSS medication distribution was established, several groups of doctors who performed the same surgeries came together to outline what they deemed appropriate for their specific procedures using historical discharge prescription habits combined with physician and provider engagement. Relying on patient feedback regarding the number of opioid pills used from a particular prescription, the clinical team began whittling down those numbers while paying close attention to patient outcomes.
When looking at the results, it’s clear why the OSS initiative was chosen to be awarded. From 2015 to 2016, OSS saw a 15 percent decrease in total prescriptions and a 33 percent decrease in the overall prescribed volume of opioid tablets. The astonishing part is OSS managed to make such a decrease at a time when patient visits were significantly increasing and its high patient satisfaction scores remained intact.
Looking at how one organization created such an impactful change can help inspire others to find strategic ways to combat the opioid epidemic.