Department of Pharmacy, Aurora Health Care

Presentation Notes

Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.


Background: Aurora Health Care’s opioid stewardship committee (OSC) was created to optimize and standardize pain management in patients while minimizing the use of opioids and reducing the number of patients who develop opioid use disorder. In 2016, the Centers for Disease Control and Prevention (CDC) established guidelines for prescribing opioids, but execution and awareness of the current guidelines is inconsistent across the system. An initiative of the OSC is to ensure that all providers are following the CDC opioid-prescribing guidelines. The specific goals of this committee are to: 1) reduce the total amount of opioids prescribed in morphine milligram equivalents (MMEs); 2) reduce the number of patients co-prescribed opioids and benzodiazepines; and 3) minimize the number of patients started on chronic opioid agonist therapy.

Purpose: An opioid-prescribing dashboard was designed to assess baseline opioid-prescribing practices and the goals of the OSC. The opioid-prescribing dashboard provides leadership visibility to MME prescribing trends and prescribing practices deviating outside the CDC opioid-prescribing guidelines.

Methods: OSC members identified important definitions and metrics for reporting in the dashboard. Metrics were adopted from literature 280 JPCRR • Volume 6, Issue 4 • Fall 2019 Supplement reviews of successful opioid dashboards at other health systems and in harmony with CDC opioid-prescribing guidelines. MME reports are the key catalyst to the dashboard’s analysis. In 2018, Aurora linked daily MME calculations to opioid prescriptions in its electronic health record (EHR). In October 2018, CDC MME conversion factors were used to validate EHR’s daily MME calculations for opioids prescribed. Incorrect or missing MME calculations were identified and addressed. An initial report was developed allowing for baseline reporting during November 1, 2018– January 31, 2019. The data was filtered by provider, specialty, and service area and then manipulated for reporting on the dashboard.

Results: During the 3-month period, 105,874 opioid prescriptions, with an average daily MME of 40, were prescribed. The average monthly MME total was 21.8 million, with 29% and 15% of patients tallying a daily MME of ≥50 and ≥90 on opioids. Aurora averaged 1229 new chronic opioid patients each month and currently accounts for 8307 total chronic opioid patients. In January 2019, 68% of patients prescribed opioids were prescribed benzodiazepines between September 1, 2018, and January 31, 2019.

Conclusion: The dashboard identifies trends and areas for improvement in prescribing opioids with the intention to encourage safe and appropriate prescribing for Aurora patients.

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