Development of an Opioid Guideline for Emergency Department Providers

The United States (U.S) is currently facing an opioid epidemic. Along with high addiction and death rates, Emergency Departments (ED) across the nation have been adversely affected by this epidemic. Individuals who use opioid medications, such as oxycodone, hydrocodone and oxycontin are four times more likely to frequent the ED. Emergency Department providers prescribe these medications daily for pain management. Research has shown that Americans are dying daily from opioids. Annually, more than half a million individuals die across the nation. In Utah, 24 individuals will die monthly from intentional or unintentional opioid overdose, a rate higher than the national rate. Alternative pain management strategies have been investigated. Promising results with the administration of non-opioid medications, such as ketorolac, and alternative therapies such as acupuncture, have been seen. The affects of this epidemic have significant financial implications as its annual cost is close to 15 billion dollars. The purpose of this project was to standardize opioid prescribing for chronic pain to patients being discharged from the ED. In order to accomplish this, a guideline was developed. The ultimate goal is for the guideline to be utilized by ED providers who work in various hospitals along the Wasatch front in the state of Utah. There were three main objectives in this project. The first objective was to assess the current perceptions ED providers have regarding opioid prescribing. The second objective was to create an evidenced-based opioid prescribing guideline for ED providers to follow when prescribing chronic pain management to patients. The third objective was to disseminate the guideline to practicing emergency providers who work in various ED's along the Wasatch front in Utah. The first objective was implemented through the use of a survey. Analyzing and interpreting the data through the use of a graph evaluated this objective. The second objective was implemented through the creation of the opioid guideline with the help of the content experts. This was evaluated through dissemination of the guideline to the targeted providers. The third objective was implemented by dissemination of the guideline in March 2017 at a monthly provider meeting. Additionally, a poster abstract was submitted to the annual Snowbird CME conference, to be held in August 2017. Results of this project showed that 100% of ED providers surveyed agreed there is a current opioid epidemic in Utah and 83% recognize that some opioids prescribed from the ED are then sold illegally. Surprisingly only 66% believed that a guideline would help educate their patients as to why they have not been prescribed an opioid for chronic pain management. The opioid guideline was well received among the ED providers and future projects will include an opioid guideline for prescribing medication for acute onset of pain. Adverse outcomes due to opioids are at an all time high in the U.S. Emergency Department providers prescribe opioids daily to patients with chronic pain who visit the ED. The development of an opioid guideline for ED providers will help standardize prescribing practices, which will reduce variability and increase safety for patients.