ERs taking steps to prescribe fewer opioids

Amid a nationwide opioid epidemic, hospitals across the U.S. have taken steps to amend protocols and train staff to minimize the prescription of narcotic painkillers, reports STAT.

Much of this work is being done in the emergency department, as EDs account for some of the highest volumes of opioid prescriptions, behind family and internal medicine, according to the report.

Among initiatives to stem the prescription of addictive painkillers are guidelines at Lexington, Ky.-based UK Healthcare that permit the prescription of opioids only as a last resort, according to STAT. In Mississippi, Columbus-based Baptist Memorial Hospital-Golden Triangle this month began limiting prescriptions to patients who are in the most acute pain. In Paterson, N.J., St. Joseph's Regional Medical Center — which has one of the country's largest EDs — has taken steps to replace opioids with alternative painkillers, such as nerve blocks, whenever possible.

However, patients' demands for strong pain medicine don't always make these clinician-patient encounters in the ED easy.

"Patients say, 'Doc, I want the strongest thing you've got,'" said Daniel del Portal, MD, an assistant professor of clinical emergency medicine at Temple University in Philadelphia, according to the report. "But patients don't always understand the risk the strongest pain medicine can create. Patients don't appreciate that until it's too late."

Still, the movement to stem the dissemination of opioids when possible is growing based on the reality that the source of many patients' addiction to painkillers is in the hospital.

"Everyone of us needs to feel like we're responsible," said Philip Chang, MD, CMO at UK Healthcare, according to the report. "The feeling of, 'I'm not an addiction specialist; that's not my problem' has to go away."

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