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Responding to the Opioid Crisis

A team approach with doctors, nurses, pharmacists & more

Addiction to opioids and opioid overdose are an ongoing national health crisis, with 47,600 opioid related drug overdose deaths reported in the United States in 2017. In answer to this, in 2018, Bryan Health and Lincoln physicians created the Bryan Health Pain Management and Opioid Stewardship Program, a powerful collaboration promoting effective pain management for patients and opioid safety for the community.

Becomes Major Problem

Pain, by definition, is physical or emotional suffering caused by illness or injury.

“The management of pain is therefore complex, requiring appropriate medical assessment and involvement of an entire health care team,” says program medical director Kelly Zach, MD, of Innovative Pain and Spine Specialists. “In the chronic pain state, pain is itself a disease, requiring treatment in which opioid pain relievers play just a small part, if any at all.

“Opioids, also known as hydrocodone, oxycodone and by other names, are appropriate to treat acute pain — that is, moderate to severe pain during the first week or so after surgery or serious injury. They also are appropriate to treat pain in patients, like those with cancer, who have severe pain at the end of their lives.

Nonopioid pain medications and pain-relieving treatments like injections and physical therapy also may be appropriate in many patients, depending on the cause of their pain.”

He points out, “Opioids have, however, been prescribed for many patients at too high a dose and for too long a time. Because of this, our society faces a very serious problem — increasing opioid addiction in our communities and a related increase in deaths from opioid overdose.

“The Pain Management and Opioid Stewardship Program really represents a culture change in how we manage acute and chronic pain. We approach each patient with a personalized care program to manage their pain using a multifaceted approach, rather than relying solely on opioids.”

Building a Team

Program facilitator Celia Weskamp, PharmD, says, “We are fortunate our executive team recognized this need and took a proactive approach to addressing it. Kim Russel, Bryan Health’s president and CEO, began by asking Bill Johnson, MD, chair of our Clinical Integration and Collaboration Committee, to discuss ways to reduce opioid-related problems that we see in our patients and in our community, and to identify factors contributing to opioid misuse, addiction and overdose.

“We talked with our physicians about how to approach the problem and quickly realized that we needed a medical director who was a pain specialist. We were very lucky to recruit Dr. Zach to lead the program. He joined us in the summer of 2018 and work got under way.”

Over the next two months, Dr. Zach and Dr. Weskamp developed the program structure with Bryan Vice President and Chief Nursing Officer Lisa Vail, DNP, who is the program’s executive sponsor. They recruited a 27-member steering team of physicians, pharmacists, nurses and others who are working to optimize effective pain management and safe use of opioids
at Bryan and in the community.

“The first thing we did was draft our ideas for the program as a three-year, 112-point action plan, which the Bryan administration strongly supported,” says Dr. Weskamp. Each member met individually with Dr. Zach and Dr. Weskamp to discuss ideas and to ensure that the plan would meet the needs of patients and providers. The team began meeting monthly last September, and progress has been rapid.

So far, that steering team has developed patient and caregiver education for patients being sent home from the hospital with opioid medications for acute pain. The information emphasizes how to safely take, and dispose of, opioid medications, and it stresses the importance of not sharing opioids. This promotes effective pain management while reducing risk for overdose and illegal use of opioids in the community.

The team also continues work on updating the overall approach to pain management for patients in the hospital, aiming to provide the safest and most effective care possible based on the most current research about pain care. Improvements have been made in how patients’ pain is measured, and new tools are helping clinicians more effectively discuss pain with patients.

The steering committee is developing guidance on using nonopioid pain medications, along with improvements for use of opioids and non-drug therapies for pain. Additional work and education in these areas will continue to improve pain management and assure optimal use of opioids. Future work by the program will include expanding these efforts to the community, other health care facilities, providers and colleges of health science.

Continuing Commitment

Dr. Vail emphasizes Bryan’s ongoing commitment to the Pain Management and Opioid Stewardship Program.

“We at Bryan understand that for every one of our patients, we have a professional, moral and ethical responsibility to do everything we can to prevent unplanned treatment outcomes. The opioid crisis currently affecting so many Americans has led to a nationwide reappraisal of pain management and how opioids are prescribed,” she says.

“Bryan supports the program because we take seriously our responsibility to provide our patients with the highest level of care and to send them safely home as they continue their recovery.”

She stresses the importance of collaboration with other Bryan services. “The Bryan Independence Center and Bryan Counseling Center serve patients who have substance abuse and other pain management needs, and the Inpatient Acute Pain Service helps care for patients who have challenging pain conditions,” says Dr. Vail. “And our telemedicine, pharmacy, nursing, rehabilitation and interventional radiology services all are important parts of the multidisciplinary pain management services we offer at Bryan.”

“We have a lot of work to do,” Dr. Weskamp adds. “The program represents significant change in how we all think about pain management, both health care professionals and patients. But the end result — safer and more effective care for our patients — will definitely be worth it.”

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