1. OPIOID SAFETY

2. Indiana Statistics

3. In Summary… About 100 Hoosiers die from drug overdoses every month, many from opioids such as heroin and prescription painkillers Indiana has the 17th-highest rate of overdose deaths of any state, according to the Centers for Disease Control and Prevention, but is one of the hardest places to find treatment in the nation As a result of the above… The legislature has been busy devising new ways to monitor our practice of medicine!

4. Recent House and Senate Bills Senate Enrolled Act 226 (SEA 226) Effective July 1, 2017 Limitation on the quantity of opioids that can be prescribed Senate Bill 243 Pilot project to pay for OB/GYN doctors to be trained in prescribing drugs such as buprenorphine for medication-assisted treatment Senate Bill 446 Pilot project to provide opioid treatment to pregnant women and mothers of newborns at three locations Senate Bill 242 Plan by 2018 to house and treat homeless Hoosiers who have a drug addiction

5. Senate Bill 156 Plan by Jan. 1 to increase the number of inpatient and residential beds for detox and drug treatment in Indiana House Bill 1438 Needle exchange programs legal now without prior approval House Bill 1019 Outlaws U-47700 in Indiana (opioid analgesic drug developed by a team at Upjohn in the 1970s which has around 7.5 times the potency of morphine) Senate Bill 151 Requires prescribers to indicate when a patient has entered into a pain management agreement Senate Bill 408 Audits the amount of money being spent to integrate INSPECT with electronic health record systems

6. SEA 226 Prescribers may not issue an opioid prescription in an amount that exceeds a seven-day supply to patients under the age of 18 or to adult patients receiving a prescribed opioid for the first time Subsequent prescriptions may only exceed seven days’ worth of opioids if issued to an adult patient for a legitimate medical purpose Exceeding the seven-day prescription limit When providing palliative care to a patient If, in the professional judgment of a prescriber, the patient’s condition requires opioid therapy for a longer period of time Both circumstances prescriber is required to document in the patient’s medical record that: (1) a non-opiate is not appropriate for the patient’s condition (2) the patient is receiving palliative care or the prescriber is exercising his or her professional judgment in prescribing beyond the limitation

7. The Joint Commission Standards on Pain Assessment and Management Leadership team for safe opioid prescribing and monitoring Must provide nonpharmacologic pain treatment Education for all Available services for consultation and referral Identification of opioid treatment programs Access to INSPECT Hospital provides equipment needed for monitoring these patients Medical staff is actively involved in opioid safety protocols and metrics

8. Hospital defines criteria for pain assessment Pain screening during ER visits Hospital treats pain or refers Hospital develops a pain treatment plan Measurable goals established Objectives and evaluations Education to patients Hospital monitors high risk patients and ADEs Objectives developed with patient as individual plan – signed by patient and caregiver Charting is extensive Patient and family education Use, storage and disposal

9. What has GCGH done to meet TJC Standards? Established an Opioid Safety Team QA, Pharmacy, Nursing, Social Services, Administration, Medical Staff Meeting each month Executive Opioid letter to Chief of staff and board Reviewing the current pain assessment policies Modifications to include goals, objectives and contracts Documentation changes to charting 2018 Pain Departmental PI Plan Goals with metrics and monitoring Thinking out of the box Alternative therapies such as aromatherapy, massage, exercise, etc List of community resources

10. How far have we come? Not near as far as we would like but we are working hard on this Each month we will have a member of the Opioid Safety team email a tidbit of information as education Formal education for medical staff – this is it! Social services working on contracts and evaluations QA working on PI plan Metrics not yet developed Pharmacy getting everyone signed up for INSPECT Investigating e-prescribing for controlled substances Investigating community services Disposal bin for controlled substances from the community Forming a list of referral sources for physicians

11. What does the future hold? It’s UGLY!!! More formal education required to be licensed More stringent prescribing practices More documentation Physician monitoring More inspections More time spent on making policies and procedures

12. Why did this come about? Insurance wants control of the world as we know it Some of us were reckless when we prescribed opioids Opioid addiction is now an epidemic Few young people have no addictions Alcohol Tobacco Drugs Food Sex Smartphones