By Kim Adel
Opioids are the third leading cause of accidental death in Ontario. In 2017, York Region reported 233 Emergency Department (ED) visits and 74 hospitalizations related to opioids*. Many of these patients were not the recipients of a prescription and were using someone else’s medication. A rise in prescription opioids and access to ‘left over’ prescribed opioids are potential contributors to these serious issues as opioids are misused or diverted into the wrong hands.
With awareness of the opioid crisis, in 2016 Markham Stouffville Hospital (MSH) launched the Opioid Task Force to promote education of pain management and safe prescribing as well as to monitor patients requiring pain medications. This interprofessional committee of pharmacists, physicians, nurses and a patient representative focused on improving pain control using safe alternatives to opioids and using opioids only when necessary.
“We want to change the mindset of physicians in which opioids are first on the list of pain management options for surgical patients,” says Dr. Paul Lokoff, Chief of Anesthesia at MSH. “We also want our patients to know that their pain will be safely and effectively managed.”
In a survey of patients, MSH found that many were not using the number of opioids prescribed to them following minor procedures. This was consistent with much of the research available on opioid reduction. Recommendations from the MSH task force align with Health Quality Ontario’s quality standards for prescribing opioids including having comprehensive patient assessments to guide pain management, providing patients with information about the benefits and harms of opioid use, as well as safe storage and disposal of opioids.
Nurses see patients before surgery and discuss patient expectations and goals for post-surgical pain control. Patients receive written instructions outlining their pain management plan. Surgeons prescribe non-opioid medications such as Tylenol and an anti-inflammatory option, as well as an opioid prescription which is often a small fraction of what had been routinely prescribed. Patients have access to a nurse practitioner in the Surgical Wellness Clinic, their family doctor, surgeon or the ED should they have a problem with their pain management.
The goals are to manage pain with the least amount of opioids possible for an individual patient and minimize the number of opioid pills that are left over in medicine cabinets. Using these tools and awareness activities for patients and staff, MSH has seen a large reduction in the number of opioids prescribed.
While the Opioid Reduction Task Force has made great strides in reducing the number of opioids prescribed without affecting the quality of patient care, MSH continues to work on innovative and safe ways to help patients manage pain.
Photo: Markham Stouffville Hospital Opioid Task Force.