South Florida Hospital News
Monday August 10, 2020

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July 2018 - Volume 15 - Issue 1


Wellington Regional Institutes New Opioid Policy

Wellington Regional Medical Center formed an opioid task force in the hospital last fall "for obvious reasons," according to Dr. Richard Hays, Chief Medical Officer. Leading those obvious reasons is the fact that the opioid problem is "a national crisis, and everyone is looking for ways to deal with it."

Dr. Hays says, “Our ER, like most around the country, has been dealing with patients seeking IV narcotics, as well as an increasing number of overdoses and overdose deaths.”
As a result, several implementations are being made to decrease the opioid usage in the hospital, and ironically, Hurricane Irma, which did so much damage to such a widespread area, helped to bring some of them about. Dr. Hays said, "The silver lining, so to speak, was that (because of the hurricane) there was an impact on the availability of legal narcotics."
He explained that last November, the pharmacy department at Wellington Regional reported it was running extremely low on several different kinds of IV narcotics; Dilaudid in particular was the one in shortest supply, and the hospital appeared to only have a two-four week supply on hand of most of its intravenous narcotics. "We seized upon that opportunity to say we needed these medications for the seriously ill, for patients having major surgeries, or others with absolute needs for that type of pain control. So with the cooperation of our ER physicians, we made a decision to post a sign that because of the shortage, Dilaudid would no longer be available in our ER."
The ER started formulating a plan to parse out other medications, to make sure the stronger ones would be available only to those patients who required them for acute pain. The plan had an almost-immediate effect. "When we completely stopped using Dilaudid in the Emergency Room, our usage went from the equivalent of 90 to 100 doses a week, to maybe 1 to 2."
Another part of the plan was to expand the use of different types of medications. Dr. Hays said that many patients who had been receiving opioids in the past probably could have gotten by on alternate medications. Now, the medical staff has been working with non-addictive medicines such as acetaminophen, ibuprofen, and muscle relaxers.
"We found that it's amazing how many people can get through joint replacement surgery – knee replacement, hip replacement – without needing opioids. We can do nerve blocks after surgery, use local anesthetic pads. We even started exploring non-pharmacological alternatives like recently approved pet therapy with a contracted pet therapy group. We have also been exploring distraction therapy, such as art projects, puzzles, and music to keep people busy so they're not thinking of their pain."
The hospital policy also changed in advance of the new state law that went into effect July 1, 2018, so that discharged patients are given a prescription for just a three-day supply of pills when they leave the hospital – realizing, however, that some people truly do need more. "Every patient is taken into consideration. However, some people have a lot of pain medications sitting in their medicine cabinet. They might be given a prescription for a three-week supply, take two pills, and have a supply left over, and sometimes that medication then falls into the hands of a person who will abuse the pills."
Dr. Hays said the hospital is looking more closely at the strength of narcotics being administered as well: "Rather than starting with a sledgehammer, we want to start with a fly swatter, if it is appropriate. We want to be able to control people's pain, but we don't want to give stronger medicine that is more likely to be addictive. We're trying to work with this problem (of pain) but not create bigger issues down the road.
"In our desire to alleviate pain, medicine has become too willing to use opioids as a first choice. The last thing we wanted to do was have someone suffer; we wanted to be able to control the pain, so we just prescribed the medication. We needed to take that back and remember that our first pledge is to 'do no harm."

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