In March 2018 when Lynn Barta, M.D., sought to change post-partum opioid prescribing habits at Rose Medical Center in Denver, she anticipated she’d get some pushback from the floor nurses. To help ensure the initiative was well-received, she worked closely with nurses, pharmacy staff and physicians to gain buy-in — and was “pleasantly surprised” by the results.
“Many Americans are struggling with opioid addiction and the medical profession has played a role in this epidemic by over-prescribing narcotic pain medication,” explained Dr. Barta, Regional Medical Director, OB-GYN Hospitalist Medicine, Envision Physician Services. “Women are at an increased risk of developing opioid-use disorders and are more likely to begin using — and misusing— opioids through medical treatment.”
Typically, patients are automatically put on a schedule of narcotic pain medication after delivery. However, as she and other healthcare leaders learned more about opioid misuse, Dr. Barta wanted to change how pain was managed at Rose.
Implementing the Initiative
While no clinician wants patients to suffer in pain, Dr. Barta wanted to change the unit’s order sets to favor prescribing non-narcotic pain medication first and narcotics as a last resort.
She worked with Rose’s director of pharmacy and nursing leadership to change the order sets. To shift long-ingrained habits, the team explained the reasons and benefits of the order set change to the nurses and made using the new order set optional for physicians. The initiative also included educating patients prior to delivery about how their post-partum pain would be managed.
“The nurses worried that patients would be in pain and that it would seem like they weren’t doing their jobs to manage it,” she said. “We asked them to try it and see how patients felt about the change.”
Fewer Opioids, Same Satisfaction
Within a week of rolling out the changes, everyone was on board. It has now become the hospital’s standard practice. Patients now receive scheduled, maximal doses of non-narcotic medication to manage their pain and lower, less frequent doses of narcotic pain medication when needed.
“It has been a huge success,” Dr. Barta said. “The nurses were surprised, and quite honestly, I was too.”
Dr. Barta reported:
- Nearly 100 percent of patients who deliver vaginally opt not to use any narcotics
- 50 percent of all C-section patients opt not to use any narcotics
- 30 percent of patients are discharged without narcotic pain medications
- Those who opt for narcotic pain medication at discharge are only given a small supply of low-dose medication
Despite fears that the initiative could affect patient satisfaction scores, the service continues to achieve scores in the 90th percentile or higher.
“We explained the new procedure to patients in advance, so they knew what to expect,” Dr. Barta explained. “Most agreed that they didn’t want to take a narcotic if they didn’t need to. Patients appreciated the explanation and said they felt more in control of their care.”
Dr. Barta said the initiative is being rolled out to Envision OB-GYN hospitalist programs throughout the country.