Intermountain caregivers continue to reduce the number of opioids being prescribed. Here is an update on progress in the Musculoskeletal and Surgical Services clinical programs.

Physicians and advanced-practice providers in the Musculoskeletal Clinical Program cut the number of opioids prescribed after orthopedic surgeries by more than 30 percent after they were shown comparative data about prescribing practices and a survey that showed they were often prescribing twice as many opioids as their patients were taking.

When Intermountain leaders set a goal in late 2017 to reduce the number of opioids prescribed to patients for acute conditions, the Musculoskeletal Clinical Program started gathering specific data about prescribing practices, said Casey Leavitt, the program’s executive clinical director. That information was put on dashboards that allowed caregivers to review several different opioid-related measures—by surgeon, by specialty, by procedure, and by facility. They also began reviewing the opioid prescribing data in weekly subspecialty meetings with surgeons across the system.

“We wanted to compare, for example, surgeons who do total joint replacement,” she said. “We didn’t want to lump all physicians together.”

The opioid dashboard would show the system averages for each procedure and physicians could see if they were prescribing above or below the averages.

Jackie Eve, PhD, data analyst, created the data visualizations for the dashboards and automated monthly emails to the surgeons with the prescribing data for their area of subspecialization. She said from December 2017 to December 2018, the number of opioids being prescribed after orthopedic surgery decreased by 30 percent. The average number of tablets prescribed at discharge dropped from 48 to 34 tablets per patient. That average is now down to 31 tablets per patient.

Overall Intermountain’s rate of opioid prescriptions after an injury or surgery is down 15 percent this year, or 416,716 fewer opioid tablets, compared to the first six months of 2018.

The Surgical Services Clinical Program also surveyed patients to find out how many pills they were using after a given procedure, Leavitt said. The team discovered physicians were often prescribing twice as many opioid pills as their patients were taking.

Gordon Kimball, MD, an orthopedic surgeon at Alta View Hospital, said after he saw the data, he made changes and he now asks his patients how many opioids they actually took after he prescribes them.

“This reporting has been one of the best things I’ve ever seen, because it’s showed me where I was,” he said. “It showed me how I compare to other physicians and it gave me a reference point so I could significantly decrease the number of narcotics I was ordering. I think I order less than half, maybe 30 to 35 percent of the number of narcotics I used to order. So the data has been extremely helpful for me.”

Leavitt said she’s heard other surgeons make similar comments after seeing the data and watched as overnight they cut back the number of opioids they were prescribing.

The Musculoskeletal Clinical Program has also worked with its advanced-practice providers (APPs), who do much of the prescribing, and selected some to be leaders in the effort to decrease the opioids being prescribed for patients.

They’ve also begun setting prescribing defaults for physicians by procedures and those have been built into iCentra, Leavitt said.

Clinical program leaders have also encouraged physicians to suggest recovering patients use acetaminophen and ibuprofen where appropriate instead of opioids, she said.

“I think there’s been this perception about opioids that they’re the best and only way to manage pain,” Leavitt said. “And acetaminophen and ibuprofen are extremely powerful and effective at reducing pain, and they don’t have the other side-effects a lot of patients really dislike, such as nausea, vomiting, and constipation.”