Athens-Limestone Hospital Committed to Opioid Stewardship and Reducing Patient Harm

April 24, 2023
for Hospital/Pharmacy/Home Health Staff
HQIC Success Story - Athens-Limestone Hospital photo

Athens-Limestone Hospital, a 71-bed hospital in Athens, Alabama, is improving opioid stewardship by implementing steps to reduce patient harm from opioids through leadership commitment, partnership with physicians and forming an opioid stewardship committee.

Previous improvement work in opioid stewardship was not continued during the COVID pandemic as the focus shifted to more urgent matters. An opioid stewardship committee is now in place and includes a diversion task force subcommittee. Representatives are from the following areas with higher opioid use:

  • One-Day Admission
  • Emergency Department
  • Anesthesia
  • Pharmacy
  • Nursing
  • Physician

Lauren Woller, PharmD, BCPS, Director of Pharmacy Services at Athens-Limestone Hospital, championed the efforts and implemented the following strategies to reduce patient harm and overcome challenges.

  1. Identify order sets containing opioids. The focus was on post-op and ortho order sets because of the high use of opioids post-op and use of range orders allowing the nurse to select a higher dose of opioids for pain. The goal was to eliminate all range orders and reduce the total MME amount available to the patient post-op.

Challenges and successes included: 1) Reaching consensus on order sets. Success followed with a physician champion supporting and leading the changes; 2) Continued to see old order sets from physician offices. Success was followed by removing old order sets from circulation.

  1. Educate prescribers on recommendations for safe opioid prescribing. The team provided category 1 CME credit covering safe opioid prescribing. This is a requirement for physicians in Alabama. The goal was to offer free and on-site and target safe opioid prescribing in the outpatient setting

Challenges and successes included: 1) Good physician turnout for the CE program. The event opened the door for good discussion and many questions from providers. Several physicians were unable to make it and expressed interest in the topic. The team would recommend offering a live virtual event in the future.

  1. Standing order for Naloxone at discharge. The goal was to include a prescription for Naloxone on all post-op orthopedic opioid discharge prescriptions.

Challenges and successes included: Physician agreement as some did not want it pushed on patients, including a perceived cost to the patients. A compromise was a standing order for naloxone available to patients at our retail location. It is currently in the final stages of development.

To view the January 17, 2023, presentation Connecting Your Hospital Culture of Safety to Patient Harm Reduction and Athens-Limestone Hospital’s presentation on Opioid ADEs, visit the Alliant HQIC website.