Scripps Reports Opioid Prescription Sizes Fall by 25 Percent

First year of Scripps’ Opioid Stewardship Program yields encouraging results

Bottle of opioid-based medication

First year of Scripps’ Opioid Stewardship Program yields encouraging results

Scripps Health has achieved a 25 percent reduction in the average number of tablets per opioid prescription ordered for patients at its hospitals and outpatient centers across San Diego County during the first year of its Opioid Stewardship Program (OSP).

Scripps created its OSP last year with the goals of reducing prescription opioid usage, preventing opioid addiction and taking advantage of other pain management options before considering opioids.

“We want to return our patients to healthy function as soon as possible, without putting them at risk for opioid dependency or the side effects of opioid usage,” said Ole Snyder, MD, a Scripps-affiliated family medicine physician and chairman of Scripps’ OSP. “We’ve designed a multifaceted approach to achieve these goals, which includes educating patients and doctors, and implementing consistent prescribing and tapering standards.”

The United States is in the midst of an opioid epidemic, fueled in part by prescription opioids. According to the Centers for Disease Control and Prevention, more than 40 percent of all opioid overdose deaths in the U.S. in 2016 involved a prescription opioid. The number of overdose deaths involving prescription opioids has grown fivefold from 1999 to 2016. 

Education and standardization

A variety of factors have contributed to the success of Scripps’ OSP. Informational handouts are made available to patients, explaining that the best way to manage acute pain is with non-opioid medications and drug-free pain relief techniques. The handouts explain that opioids should be considered only after other non-opioid approaches have been tried.

The program also focuses on educating health care providers, including formal online education modules created for physicians, nurses and pharmacists. Additional physician education has taken place through grand rounds, department meetings and individual conversations. 

In addition, the Scripps OSP established a prescribing standard, which limits the number of opioid tablets issued in prescriptions and encourages the use of tapering schedules and partial prescription fills. An online OSP resource center has been created to centralize prescribing tools, community resource information and patient and provider education materials. Scripps recently opened three drug take-back kiosks adjacent to its on-site pharmacies, offering year-round access to dispose of unused, unneeded and outdated prescription medications.

“We’re pleased with the results from the first year of our program, and we believe this is just the tip of the iceberg; there is still a lot of opportunity for further improvement,” said Valerie Norton, MD, physician operations executive at Scripps Mercy Hospital San Diego and a founding member of the Scripps OSP steering group.

The data were collected between October 2017 when the OSP was launched and September 2018, using Scripps’ Epic electronic health record (EHR), which has been adopted at Scripps in phases during the past 18 months.

Looking ahead

Scripps physician leaders expect to enhance the OSP by adding decision support for opioid prescribing through Scripps’ new EHR. They also expect to add formulary management and pharmacist authority to lower prescribed doses for patients new to opioid use.

Later phases of the program will address chronic and complex patients who are already opioid-dependent to make sure they have access to appropriate treatment.

With its integrated EHR now fully implemented, Scripps will have the capability to establish baselines for total opioid prescriptions ordered and total tablets prescribed at its hospitals and clinics. Scripps expects to track trends in these additional areas in the months and years ahead.

The Scripps OSP is led by a multidisciplinary group of clinicians who received a HealthTrust innovation grant in 2017 to build a program to manage surgical pain with minimal use of opioids. In addition to Drs. Snyder and Norton, the steering group includes M. Jonathan Worsey, MD, and David Dockweiler, MD, who are co-chairs of the Scripps surgery care line; John Gama, pharmacy clinical coordinator; and Saba Rab, advanced practice pharmacist.

Learn more about Scripps Health, a nonprofit integrated health system in San Diego, Calif.

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Steve Carpowich

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