System, community approach to opioid epidemic
Gundersen clinicians and frontline clinical staff are staying updated on internal and external pain management guidelines and best practices. Their efforts are making an impact. The number of opioids prescribed system-wide at Gundersen dropped 31% in 2018; pills per prescription decreased 26%.
Progress at Gundersen
The successful reduction of opioids prescribed and decrease in pills per prescription was possible from Gundersen's multi-faceted approach to pain management. In 2018, the system:
- Developed a medical coordinator role to support clinicians who have prescribing questions or need help managing patients' pain (Stephanie Neuman, MD; Kimberly Hardy, MD; and Christopher Eberlein, MD)
- Implemented "blister packs" of Tylenol and ibuprofen in emergency and urgent care areas for patients with acute pain, with primary care clinic implementation slated for 2019 (Research has shown taking Tylenol and ibuprofen together can be more effective than taking oxycodone for acute pain.)
- Developed metrics available to all prescribers to track system progress
- Created clinician pocket cards for responsible opioid prescribing and acute pain management
- Provided clinicians in-person and on-demand opioid prescribing and pain management education
- Launched an internal pain management website for clinicians
- Created a monthly medication management forum for clinicians to discuss difficult cases or learn more about pain management.
Alliance to HEAL in Action
Gundersen and more than 100 community members in the Alliance to HEAL (Halting the Effects of Addiction Locally) are working to cut the supply of drugs in the area and show people that life is better without drugs.
The Alliance has four goals: 1) decreasing the supply of opioids; 2) increasing the number of people in treatment; 3) decreasing the fatal overdose rate; and 4) decreasing the non-fatal overdose rate.
Large gaps in treatment were identified by Alliance to HEAL members. One hundred people who had gone through treatment locally were surveyed, and it was found the average length of time to get into treatment was 30 days. The Alliance to HEAL is working to reduce the time it takes to get into a treatment program to 24 hours.
"As a community, we're also sending some people two hours away to get treatment," says Sandy Brekke, senior consultant, Gundersen Office of Population Health, and an Alliance to HEAL member. "Alliance to HEAL members are creating a business plan for a local treatment facility that will address initial treatment through follow up treatment five to 10 years in the future. In the meantime, how do we fill the gaps? Who can treat patients? This is what the Alliance to HEAL is trying to figure out."