Finding Hope


FINDING HOPE: How Intermountain Healthcare lowered opioid prescriptions by 3.8 million pills in 2018

Doctor database pinpoints number of needed pills
Posted at 6:07 PM, Apr 01, 2019
and last updated 2019-04-02 16:44:25-04

SALT LAKE CITY, Utah — As the opioid epidemic claims lives across the country, many people are placing blame on pharmaceutical companies and physicians for overprescribing medications now known to lead to addiction and dependence. As a result, Intermountain Healthcare, the largest healthcare system in the Intermountain West, is making it a top priority to send patients home only with the number of pills they need to adequately treat their pain post-surgery.

Doctors with Intermountain reduced the number of opioid prescriptions sent home in 2018 by 3.8 million pills, while also making major strides toward educating every person that walks through their doors about the potential addictive side effects of many medications.

"What we have found is we can prescribe at least 50 percent less than what we were currently prescribing," Dr. Jay Bishoff said.

In 2017, Intermountain started a database, compiling information from 170,000 patients after all kinds of surgery--hysterectomy, eye surgery, kidney stones, broken arms, knee replacements, etc. Their main areas of focus: Was your pain adequately controlled? And did you take home more prescription painkillers than you needed?

The results have been eye-opening for physicians.

"Now we can say, 'Look, you've been giving 30 Percocet tablets to patients who've had kidney stones.' They're going to take, on average, four. And it turns out in Urology the sweet spot is really around ten pills--no matter what we do to you," Dr. Bishoff said. "For other surgeries, a little more invasive, it's about 12-15, but it's not these high numbers of 60 or 30 that we used to prescribe. It's much less than that."

Doctors even take into account whether or not the patient has a higher tolerance for opioids coming into surgery, depending on medications for other conditions.

"So the physicians can go into the electronic medical records and see, 'OK, I just did a knee replacement on somebody who's taking narcotics coming into surgery, what's the average number that they consume?'" Dr. Bishoff explained.

Intermountain's physicians then typically send home two prescriptions: One to manage pain in the immediate days following surgery and a second dated prescription that can't be filled until a week later, so just in case they need it, they have it.

Since the start of the shared database, the healthcare system has seen a significant cutback on the number of unneeded pills sent home.

"Having done that across the system, we've decreased opioid prescriptions by 24 percent," Bishoff said. That tallies up to the equivalent of 3.8 million pills in just 2018.

"That's a lot of pills that weren't going to be used for good reasons," Dr. Bishoff said.

By no means are these physicians trying to limit painkillers for chronic pain patients who need them. When we talk about opioid use, it's extremely important to separate needs for acute pain and for chronic pain.

"Acute pain is something we expect to go away. Chronic pain is something that is a chronic disease, like diabetes or back pain, or high blood pressure that needs constant management until the pain goes away. And for some it never goes away, so it needs constant management," Dr. Bishoff said.

Intermountain Healthcare has also implemented a program called "Speak out, Opt out, Throw out" educating patients so they know they don't need to take opioids if they don't want to.

"Patients will now say, 'Do I really need to take these? I'm going to take the prescription, but I'm not going to fill it unless I need it,'" Bishoff said.

The healthcare system has also helped fund billboards around town, along with increasing signage within the hospital itself, educating patients about the addictive aspects of many medications.

"We've put wraps all over in the hospital. Like in the surgery waiting area where your family is waiting for you to come out of surgery, we have literature in there--[signs] about the dangers of opioids," Bishoff said. "So by the time you come out of surgery and you're ready for discharge, we've hit you and your family to say, 'hey look, these can be dangerous substances.'"

They're also sending patients home from surgery with informational cards about the importance of not keeping unneeded pills around after the healing process. So as a part of "Speak Out, Opt out, Throw out," they've also increased the number of drug take-back bins in each of their hospitals and pharmacies.

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