Beaumont Health, Michigan’s largest healthcare system, is participating in a collaborative project with other hospital systems throughout the Midwest to reduce opioid prescriptions for common pain syndromes in patients who present to the emergency department (ED). All nine EDs at Beaumont Health joined the ALTO Project (ALternatives To Opioids), which the Colorado Hospital Association started as a pilot program to reduce the administration of opioids in EDs. The successful pilot recorded a 36 percent reduction in opioid administration over a six-month period.
“Our goal is to be ‘opioid-sparing,’ so we’re trying to follow certain modalities prior to moving to medications containing opioids whenever appropriate,” says Heidi A. Pillen, PharmD, director of pharmacy, clinical services and medication use policy, Beaumont Health. “Prior to our February 1 go-live date, we conducted extensive nursing, physician and pharmacy education, developed order sets approved by the pharmacy & therapeutics committee, and rolled out a public relations campaign.”
For its study, Beaumont Health targeted six common pain syndromes: renal colic, musculoskeletal pain, acute and chronic radicular low back pain, headache, extremity fracture/joint dislocation and chronic abdominal pain/gastroparesis. It also identified non-opioid pathways for pain management such as typical multimodal analgesic agents, including acetaminophen, ibuprofen, gabapentin and lidocaine patches, along with more novel approaches like trigger point injections, intranasal lidocaine and ketamine, and analgesic ketamine infusions.
“While it is too soon to chart our results, we do have several anecdotal reports of patients with chronic pain syndromes expressing excellent pain relief following use of the ALTO protocols,” Pillen adds.