Medicines are used to treat diseases, manage conditions, and relieve symptoms. Medicines are generally safe when used as prescribed or as directed on the label, but there are risks in taking any medicine. Each year in the United States, adverse drug events – harm resulting from medication use – cause more than one million visits to hospital emergency departments.
More than 100 die from drug overdoses every day in the US. Most deaths are caused by prescription medications. In 2011, more than 1.4 million Emergency Department visits were related to pharmaceutical events. WHA will assist hospitals with strategies to implement best practices to reduce opioid-related adverse events, improve appropriate pain management, decrease the use of opioids, and enhance patient expectation management. These resources are designed to provide updated education, assist hospitals in discovering opportunities to improve, and applying scientific methods to reduce adverse drug events in the hospital.
The Midwest ALTO Project, based on the Colorado ALTO Project, is a permanent change to the prescribing practices in Wisconsin’s emergency departments. It is an evidence-based program that institutes the 2016 Wisconsin ACEP Opioid Prescribing Guidelines in a way that is sustainable and effective. The program is designed in a train-the-trainer style so that it can be implemented in new EDs by each facilities’ project champions after they have received training from Great Lakes Partnership for Patients Hospital Innovation Improvement Network (GLPP HIIN) experts. The trainings cover four key areas of ED staff: physicians and advanced service providers, nurses, pharmacists and IT/data support groups. The GLPP HIIN has developed training materials, guidelines and in-person training sessions to help each ED implement the ALTO Program successfully. More information on ALTO can be found at https://cha.com/opioid-safety/colorado-alto-project/
Wisconsin ACEP Resources:
- Guidelines for Opioid Prescribing in the Emergency Dept. (link)
- WACEP Alternative to Opioids (ALTO) Pathways (link)
- WACEP Patient Pain Management Handout (link)
Aligned with the American College of Emergency Physicians, WHA is assisting Emergency Departments to initiate medication-assisted therapy (MAT) for patients with opioid use disorder. Protocols are being adopted to include screening for opioid use disorder, initiation of MAT, and rapid referral to ongoing community-based treatment.
Buprenorphine in the ED Webinars:
- Buprenorphine 101 Demystifying Medication Assisted Treatment in Wisconsin (link)
- A Quick-reference Guide for Prescribing Suboxone in the Outpatient Setting (link)
- Developing an ED-Initiated Buprenorphine Program (link)
- MAT and the EM Workforce InfoGraphic (link)
WHA is supportive of Emergency Departments prescribing and dispensing naloxone (opioid overdose rescue medication). Several hospitals are dispensing take-home naloxone kits.
As an Executive Committee Member of the Surgical Collaborative of Wisconsin, WHA supports efforts to combat Wisconsin’s opioid epidemic with data-driven leadership resources for community surgeons. This includes engaging and partnering with surgeons and statewide leaders for best practice sharing, analyzing opioid prescription fills following surgical procedures in Wisconsin to identify best practices and opportunities for education and prescription reduction, distribution of surgeon-level prescribing reports with statewide benchmarks to surgeons, and creation of both distance learning and in-person opportunities to discuss and refine best practices for opioid prescribing.
Surgical Collaborative of Wisconsin Resources:
HRET ADE 2018 Change Package
Adverse Drug Events - Opioids YouTube Videos
Perioperative Pain Management: Challenges in the Era of the Opioid Crisis
- Opioid Initiative Summary (link)
- Toolkit: Reducing Postoperative Opioid Prescribing (link)
- Safer Prescribing of Opioids after Trauma and Surgery Webinars (link)
Challenges in the Era of the Opioid Crisis - Drug Disposal
Challenges in the Era of the Opioid Crisis - Education and Expectant Management
Challenges in the Era of the Opioid Crisis - Addiction Risk
Challenges in the Era of the Opioid Crisis - Multimodal Analgesia