By Payne Horning
It’s custom at Oswego Health for patients who undergo surgery to receive a call from a physician or nurse one month out from the operation. It’s a checkup to see how they are feeling and to learn about any potential complications.
Last year, a new question was added to this list for those patients who had been prescribed opioid medication to manage the postoperative pain. “How much of the medication did you actually use?”
The answer was unexpected.
“It was really eye opening when we followed up with the patients and found that over half of them were not using all of the medication that had been prescribed,” said Lisa Annenberg, surgical quality management specialist at Oswego Health.
Annenberg says this was disconcerting for two reasons. It revealed that many of the opioid pills making their way out into the community were unnecessary. And even more troubling, this was happening at a time when county wide data showed a real problem with opioid prescriptions per capita in Oswego County and overdose deaths related to opioids.
The issue, as it turns out, was not limited to Oswego County. The entire region was struggling with the same problem. So, a group of surgeons and nurses came together to collaborate on a solution.
The result was the creation of a set of best practices and prescribing guidelines for patients who have undergone any one of 21 different procedures.
“It’s all about responsible prescribing,” Annenberg said. “The overall goal for all of us involved in health care when it comes to the opioid crisis is to reduce the number of opioids available for diversion, to make sure that the opioids being prescribed are actually needed.”
The procedures targeted range from knee replacement to incision-less surgery for bladder tumors.
It’s been adopted by surgeons at 18 hospitals and health centers in Upstate New York, including Oswego Health, St. Joseph’s Health Hospital and Upstate Medical University. Excellus BlueCross BlueShield is also contributing to the effort through its data analytics.
Although the goal is to cut down on the number of opioids making their way into the community overall, the guidelines are not mandatory.
Katie Pagliaroli, director of quality and patient safety at Oswego Health, says the group has committed to providing patient-centered care so people who need more assistance managing their pain are not limited, such as those with chronic pain. The surgeons still make the final call on how much to prescribe and there is a mechanism built into the program where patients can be reevaluated if the amount of medication ordered was insufficient.
“The guidelines are just those — guidelines,” Annenberg said. “We look at the guidelines to reduce the number of postoperative opioids, but individually, prescriptions have to take into account the patient’s needs.”
In addition to the new prescription guidelines, Oswego Health is working to reduce the number of opioids in the county through a drug takeback initiative. The hospital successfully applied for a grant to put in a drug take back box that’s accessible to the public. The secure collection bin is located just outside the entrance to Oswego Hospital’s emergency department on West Seventh Street, open 24 hours a day.
Pagliaroli says tackling this problem as a group will not only curtail a larger amount of opioids pouring into the region but also improve the project’s approach. The participating hospitals and health centers will continue to meet periodically to review data and analyze the success and shortcomings of the program.
“As time goes on, we learn a lot about what does work and what doesn’t and that’s why it really truly is a science because we don’t always have a crystal ball to foresee the future,” Pagliaroli said. “But I think when we work together in a large enough group with other hospitals, that helps us learn even more.”