238 Reduction in opiate administration in emergency department patients following implementation of alternatives to opiates program

Document Type

Conference Proceeding

Publication Date

4-27-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: The opioid overdose epidemic has worsened causing 80,000 deaths per year in the US. Alternatives to Opiates (ALTO) programs are pain management algorithms that support emergency department (ED) clinicians to treat pain using non-opiate medications, decreasing patient exposure to opiates. We developed an ALTO program to reduce administration of opiate medications within 9 EDs of a regional health system. We targeted a 30% reduction in morphine milliequivalents (MME) administered in the ED per hour of length of stay (LOS).

Methods: A multi-disciplinary group developed an ALTO program using existing practice patterns and available literature and implemented a “Quicklist” in the electronic medical record to organize orders for non-opiate analgesics, allowing for greater ease of ordering. The ALTO program was implemented with preceding education, in the form of text resources and in-person forums, provided to ED clinicians and nursing staff. The program was implemented in November 2019. Feedback regarding the program was communicated at 4-month intervals via email. All 9 EDs participated in implementation and maintenance of the ALTO program and have an annual volume of nearly 450,000 patient visits. We calculated the total number of MMEs per encounter using standard conversion factors as well as the total number of ED LOS hours during the study period. These were used to calculate the MME per hour of ED LOS, which was then compared between the 36-month baseline period and the 47-month post-implementation period.

Results: In the 36-month period prior to ALTO implementation there were 4,937,743?MME administered system-wide to patients across 7,890,174 total ED LOS hours for an average of 0.63?MME administered per hour of ED LOS. In the 47-month period post-ALTO implementation there were 4,330,151?MME administered over 10,169,620 total ED LOS hours for an average of 0.43?MME administered per hour of ED LOS. These results demonstrate a 31.7% decrease in opiates administered as measured in MME per hour of ED LOS.

Conclusion: The ALTO program was associated with a decrease in opiate administration across a regional health system with a large annual patient volume. Standardized opiate administration as measured by MME per hour of ED LOS can help account for variables including fluctuations in volume and boarding. Continued program education is needed as is further study on associated patient-centered outcomes.

Volume

31

Issue

S1

First Page

116

Find It @ Sladen

Share

COinS