The rate of reduction of opioid prescriptions in the Emergency Department (ED) is increasing more and more throughout the country. A hospital I was part of started their campaign back in 2016. The Chief Medical Officer was supportive, and the journey started with comprehensive education for physicians, pharmacists and nurses. A physician speaker, who had front line experience with treating patients for pain as well as addiction, was brought in to educate staff on alternatives to opioids that really work. The seminars were open to nurses as well as physicians because no real change in opioid prescribing can take place without the buy-in from the front line nurses. I saw the perfect example of this.
The day before one of these educational talks was to take place, I did a walk through the ED to personally invite as many staff members as I could. The ED Chief was at the nurses’ station reviewing a patient’s chart. I reminded him of the date, time and subject of the talk and encouraged him to attend. I could see he really had no intention of attending. As we were talking, a nurse walked up and heard my invitation to the Chief. She then said, “Doctor you really need to go to this because you are one of the worst at prescribing opioids”. We both looked at her and she followed up with, “I’m serious, you give opioids to everyone. You should go to hear this talk.” Besides the fact that this nurse clearly felt safe enough to speak up (which tells you something about the culture), she was also the impetus behind getting the ED Chief to the talk. He attended, he listened, and he was convinced to make changes. His support began the journey that led to a reduction in opioid prescriptions in the ED by 50% within the next 16 months.
Since this time, I have heard from multiple healthcare providers at various conferences (IHFDA, CSHP Seminar and ASHP Mid-Year) and read journal articles about all facilities that are getting good results reducing the prescription of opioids. I want to encourage you to keep going or get started! The opioid crisis is multi-pronged. Reducing prescribing opioids in the ED is just one arm of it, but it is a start and an area you can have an impact.
Status quos are made to be broken — Ray A. Davis
