The
Massachusetts Health & Hospital Association (MHA) and Tufts Medical Center,
working with hospital clinicians and operational staff in Massachusetts and
other states, have developed two documents to help hospitals develop internal
policies to prevent opioid misuse by patients admitted for care and treatment.
The new Inpatient Opioid Misuse Prevention Guidelines and Patient and Family Agreement
on Opioids are now available on MHA’s PatientCareLink
website.
“Our
nation’s opioid epidemic has become the great equalizer. No zip code, no income
level, no background, is immune from its devastating reach. It will take
all of our best and collective efforts to solve this complex problem that has
already taken far too many lives. Hospitals on the front lines of this battle
are committed to using our resources and expertise to develop and effect
solutions. We’ve led the way on implementing prescription limits, which
is beginning to make a significant difference in reducing access to opioids,”
said Steve Walsh,
President & CEO of MHA. “We are gravely concerned knowing
that addicted patients bring heroin or non-prescribed opioids with them to the
hospital, or try to obtain illegal drugs during their stay. Today, we announce
a new component in our initiative to prevent unlawful and dangerous opioid use
within hospitals. We are working in tandem with our member hospitals and
other concerned groups to launch inpatient guidelines and a patient/family
agreement to provide a first-in-the-nation, comprehensive, statewide framework
to screen, manage, and treat patients with Opioid Use Disorder (OUD).”
“How we
manage this epidemic inside our hospitals is of utmost importance. Hospitalized
individuals with Opioid Use Disorder (OUD) are at increased risk of leaving
against medical advice, suffering painful withdrawal symptoms, and dying from
an overdose post-discharge if their tolerance for opioids goes down during
hospitalization,” said Deeb
Salem, MD, Tufts Medical Center co-interim CEO and chair of the Department of
Medicine at Tufts University School of Medicine. Dr. Salem
co-authored the documents with
Steven Defossez, MD, MHA’s Vice President for Clinical Integration,
Tufts
University School of Medicine student Ifeanyi
D. Chinedozi, and Tufts University student Megan V. Fernandez,
now at University of Massachusetts Medical School.
“We want to
assist hospital-based clinicians to care for patients with Opioid Use Disorder
(OUD) with both evidence-based best practices and compassion,” Dr. Defossez
said.
The Inpatient
Opioid Misuse Prevention Guidelines identify best practices
(clinical practices and operational policies) to optimize patient care. These
include specific instructions regarding:
- Screening
for opioid use disorder among patients admitted for inpatient level care;
- Prevention
of inpatient acute opioid withdrawal through medication assisted therapy;
- Prevention
of and response to an opioid overdose ;
- Management
of acute pain in the setting of chronic opioid use;
- Preventing
patients from bringing opioids into a hospital ;
- Working
with visitors to prevent inappropriate opioid use or bringing in opioids
during visitation;
- Educating
patients on the risks of opioid misuse;
- Security
de-escalation; and
- Care
coordination for patients refusing to follow zero-tolerance of opioid
misuse.
The Patient
and Family Agreement on Opioids was written specifically
for patients, families, and visitors. It states that the care team is committed
to the patient’s recovery and wellness, and that facilities offer patients
options to assist them on their road to recovery. This includes
medications to keep them from going into withdrawal while they are hospitalized
as well as assistance in finding available services following their discharge,
if they so choose. The document also spells out the obligations of a patient’s
family and visitors to help achieve this goal, including a patient-centered
zero tolerance for inpatient opioid misuse. Included in the document are a
template consent form for the OUD patient to sign and a separate template
consent form for family members and visitors of patients suffering from OUD.
The latest
opioid guidance builds on efforts from MHA and the hospital community to curb
the opioid crisis. Previously, MHA convened a task force that included a
multi-disciplinary group of clinicians and operational staff to develop and
issue an array of guidance and informational sheets to help improve opioid
prescribing practices within hospitals. The materials also provide
standards for screening patients seeking opioid prescriptions, offer
information on appropriate pain management and treatment, and help identify
resources for patients needing substance use disorder treatment. The materials
include patient and provider fact sheets about the risk and harm of opioids,
suggestions for the proper storage and disposal of opioids, and suggestions on
improving internal education of clinicians to help them limit and find alternatives
to using opioid pain medications. All of these materials, as well
as this recent set of guidance documents, are available on the MHA’s PatientCareLink website.
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