Using Untapped Data To Inform Opioid Stewardship In the Hospital
By Richard Dion, PharmD, pharmacy clinical program manager for clinical surveillance and compliance, Wolters Kluwer Health.
In recent years, the data collected by health systems has skyrocketed in volume. Unfortunately, studies show that up to 97% of data collected in hospitals is not used to inform or improve care — an issue that could offer new opportunities for both providers and patients. Hot-button topics like inpatient Opioid Stewardship could benefit from an increased utilization of available data.
Institutions looking to leverage existing data to improve quality and safety of opioid use should consider several steps to create meaningful and attainable data-backed goals.
From the outset, it’s important to consider who would drive these programs within hospitals and health systems. Leadership roles, as well as day-to-day drivers of activities, will require thoughtful selection and designation. Leadership plays a critical role in overall organizational buy-in, while pharmacists within a health system can provide the education and support necessary for physicians to optimize electronic healthcare records (EHR) and other data to provide appropriate pain management options. With the recent relaxation of opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC) to no longer promoting strict thresholds for pain medication doses and duration, developing standardized opioid stewardship programs based on local data is critical.
When it comes to analyzing existing information for care decisions, utilizing local data is vital to a complete understanding of opioid use and patient needs within the health system. Some EHRs and third-party applications may have metrics and dashboards available, but sites may need to curate their own data to fit organizational needs. Technologies such as dashboards that offer a composite view of patient and prescribing data are invaluable to providers to identify patterns and at-risk patients. There may still be several areas where manual processes are prevalent and / or necessary. While individualized care for patients is important to maintain, creating structure using automation that can help identify patterns and insights from data can be invaluable in preventing and treating opioid use disorder (OUD) efficiently and effectively.
As health systems and programs evaluate current programs and look to leverage existing data, a few common metrics to consider include:
- Pain management metrics (e.g., morphine milligram equivalent data, long acting/extended-release opioids for naïve patients)
- Patient assessment (e.g., pain goal documentation)
- Discharge opioids (e.g., prescriptions for supply of > 7 days, MME > 50/day)
- Patient outcomes (e.g., Severe pain scores, naloxone administrations)
There is no “one-size-fits-all” metric to build around, but rather, teams should consider variables like timeliness, usability and feasibility of metrics. Consider not just the data available but also the long-term implications of its collection and availability. For hospitals initiating their opioid stewardship programs, integrating local data like MME calculations into processes for prescribing opioids may be a critical early step. Once a health system has identified specific metrics to track —with considerations to target population, exclusions, measurement periods, and data sources — leaders can begin to build out dashboards, reports, alerts and internal processes to develop these databases into actionable items.
Automated dashboards may help address challenges posed by staffing shortages without compromising patient safety. By adding automated tools that can identify and integrate the most relevant data sources, hospitals can reduce the manual burden on teams, ensuring their time is spent on activities that add value for patient care as opposed to administrative data entry and collection.
As health system leaders tackle the challenge of organizing data into valuable frameworks for opioid stewardship, they’ll face critical questions. Leaders will want to re-evaluate staff training, workflows and data integration to optimize existing resources to leverage data into actionable insights and ensure appropriate interventions. Teams will need to have a plan for large-scale educational initiatives coupled with 1-on-1 detailing with providers. With the relaxation in CDC guidelines allowing more ownership over opioid management, hospitals will need to consider the increased scale of providers with access to previously restricted therapies. Building out evidence-based, data-centered processes to do so is one more step to protect and provide the best-quality care for patients possible.