November 28, 2018 - Kicking off day two of MEDITECH’s Physician & CIO Forum, Dan Hale, MD, FAAP, SFHM, chief professional development officer at Lawrence General Hospital, and Janet Desroche, associate vice president at MEDITECH, led a discussion on addressing the opioid crisis. According to the Centers for Disease Control and Prevention (CDC), “The annual number of prescription drug overdose deaths has quadrupled since 2000. From 2000 to 2016, more than 600,000 people died from drug overdoses.”
The audience responded to Janet’s opening question with their hands in the air — illustrating a nearly unanimous “yes” — acknowledging their lives have been touched by the opioid crisis. Janet went on to explain that 115 Americans die every day, and opioid use disorder needs to be treated like a disease. Prior to introducing Dr. Hale, she discussed several ways the government is trying to help, including the Support for Patients and Communities Act, electronic prescription drug programs, and Jessie’s Law — the ability to flag a patient’s history of opioid addiction within the EHR. Next, Dr. Hale took the stage and tackled the following topics.
Dr. Hale said the opioid crisis is bigger than the HIV/AIDs epidemic — “It’s going to take a village to prevent that number from going higher.” He noted the following factors as important pieces in working toward a solution:
Neonatal abstinence syndrome (NAS) refers to a group of problems an infant experiences after being exposed to addictive drugs while in utero. Unfortunately, NAS patients are flooding hospitals, and their length of stay is increasing. Withdrawal in a newborn is characterized by (1) central nervous system hyperirritability (e.g., seizure or tremor), (2) autonomic nervous system dysfunction (e.g., fever, respiratory rate changes), and (3) gastrointestinal tract dysfunction (e.g., feeding issues, vomiting, loose stools, weight loss). In the past, a NAS patient was taken from their parents, put into state custody, and admitted to the neonatal intensive care unit (NICU) for a month — essentially sedated with morphine.
The new way, however, encourages “rooming in” to promote baby and parent bonding — pending the parents are in recovery or actively working toward recovery. Non-pharmacologic interventions that truly help NAS patients include holding/cuddling, skin-to-skin, swaddling, pacifiers, limiting stimulation, and breastfeeding (if eligible). Dr. Hale also mentioned the importance of cuddlers — volunteers who come into the hospital to hold the babies. Within one week of sending an email out, Lawrence General Hospital obtained 180 signatures from community members who wanted to take on this rewarding role.
From a medical standpoint, the first line option for NAS patients is opioid replacement, such as neonatal morphine solution (NMS), methadone, or buprenorphine. The second line is phenobarbital or clonidine. Fortunately, data shows the non-pharmacologic interventions lessen the use of morphine, adjunctive phenobarbital use, and length of stay — resulting in a savings in cost of care.
Lawrence General Hospital utilizes the following tactics to combat the opioid epidemic. Do you employ any interventions to help improve this crisis? If not, consider implementing one of the practices below:
Rightfully so, Dr. Hale’s next topic of discussion was how health IT can help to fight against opioid addiction, specifically:
To conclude the presentation, Janet thanked Dr. Hale for his inspirational efforts. She went over the CDC Guideline for Prescribing Opioids for Chronic Pain and discussed MEDITECH’s Opioid Management Toolkit, which will be done in phases. The initial phase will look at identifying patients at risk for addiction, managing patients who are prescribed opioids, and identifying other modalities to manage patient symptoms. This toolkit, designed to take advantage of our latest and greatest Expanse functionality, will be released at the end of this year to early adopters.
Circling back to Dr. Hale’s comments about the opioid crisis being a village effort, attendees were energized by Lawrence General Hospital’s endeavors and encouraged by MEDITECH’s initiatives to combat this unfortunate epidemic.