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Department

Pharmacy

Position/Job Title

PGY-1 Pharmacy Resident

Description

Purpose: The purpose of this study is to define the root cause of high morphine milligram equivalents usage, defined as morphine milligram equivalents (MME) greater than 50 milligrams, within Henry Ford Jackson Hospital (HFJH) compared to other hospitals within the Henry Ford Health System. By conducting this analysis, the study aims to uncover factors contributing to the elevated opioid prescribing rates at HFJH and to explore strategies to optimize prescribing practices, thereby improving patient safety and reducing the risk of opioid misuse. Methods: The inclusion criteria for this study require participants to be 18 years or older admitted to HFJH between January 1, 2023, and January 1, 2024. They must have received at least one scheduled order of morphine or a morphine equivalent (e.g., buprenorphine, codeine, hydromorphone, fentanyl, methadone, oxycodone, or tramadol) at a dosage of 50 MME or greater during their hospital stay. Exclusion criteria include hospice patients or individuals with terminal illnesses receiving palliative care, intubated patients on fentanyl infusion, and vulnerable groups such as children, pregnant women, and incarcerated individuals. This study will use a retrospective, descriptive medication use evaluation design. Historical data from electronic medical records will be reviewed to assess opioid prescribing practices and protocols. The study will employ statistical and qualitative analyses to identify patterns and discrepancies in high MME prescribing, focusing on opioid trends, departmental variations, and adherence to naloxone protocols. A cohort of eligible patients will be compiled through data extraction, with each assigned a unique identifier. Using a random number generator, 100 patients will be randomly selected from this pool, replacing any who meet exclusion criteria. Extracted data will include patient medical record number (MRN), admitting diagnosis, opioid prescription details, naloxone orders, pain scale, authorizing prescriber, and primary service. Results: This study found internal medicine and postsurgical care to have the highest opioid prescribing rates within HFJH, leading with internal medicine. This trend is likely influenced by the substantial number of patients with substance use disorders managed within this service, contributing to the elevated average MME per day. Additionally, naloxone prescribing at HFJH remains inadequate, as 60% of patients discharged with an opioid prescription did not receive naloxone, highlighting a critical gap in harm reduction efforts. Conclusion: Several departments of HFJH exhibit patterns of high-dose opioid prescribing as well as a lack of naloxone prescribing, indicating a gap in knowledge or adherence to best practices. This highlights the need for focused education on pain management, particularly for postoperative care, to promote more appropriate prescribing and reduce reliance on high-dose opioids, improving patient safety and minimizing overdose and addiction risks.

Publication Date

4-15-2025

Keywords

Henry Ford Jackson Hospital Research Symposium, quality improvement

Decoding High MME Opioid Usage: A Root Cause Analysis of HFJH Outlier Status Within the System

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