Central to the practice of medicine is the provision of quality and safety healthcare. In other words, it is the goal of each medical practitioner to ensure that the services that are provided are not only consistent with current professional knowledge, but that they should also contribute to significant improvements in terms of health outcomes for patients. While these are the inherent blocks of the healthcare industry, it is also important to acknowledge that considerable challenges remain prevalent within the system. Essentially, one must recognize the fact that human beings are liable to mistakes from time to time. However, when it comes to the practice of medicine, most of the errors that are reported come about as a result of faultiness in processes or systems (Vincent & Amalberti, 2016). It is this for this reason that is advisable for hospitals to develop up-to-date, effective and efficient strategies for the improvement of quality as well as the enhancement of safety.
One topic that comes to mind when discussing matters regarding patient safety is that of opioids. As of October 2016, the number of opioid-related deaths stood at 28,000 with over half of them being linked to opioids that had been prescribed in various medical facilities (Kim, Nolan, & Ti, 2017). It was around this time that the American healthcare system became aware of the crisis and risk posed by the use of opioids in the medical world. The use of opioids in the medical world remains a topic of major debate on the issue of contention being the side effects that come with the drug. Opioids are crucial medicines when it comes to pain management. In this case, therefore, they remain a core element of healthcare analgesics. The human brain has opioid receptors all over its central nervous system. In this case, the analgesic effect comes about when the opioids bind to and activate these opioid receptors. The challenge that is realized with the use of opioids is that opioids have diverse effects on the central nervous system. For medical practitioners, the opioid crisis tends to create a dilemma in which they are left to choose between helping the patient manage pain at the risk of addiction and possible overdose resulting in death.
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Patients on opioid prescription often report side effects including nausea, constipation, and vomiting, respiratory depression as well as urinary retention. From a psychological point of view, opioids tend to produce a sense of euphoria alongside pain relief an issue that tends to encourage its misuse. In terms of economics, opioid-related cases tend to come along with numerous healthcare costs. This comes about because most of the patients that are put under the opioid prescriptions tend to experience prolonged hospital stays. Looking at existing data on the issue of opioid use from the National Action Plan for Adverse Drug Event Prevention , the dispensation of opioids is said of have doubled between 1999 and 2010 (ECRI Institute, 2015). In this case, therefore, it is evident that this is a crisis that has been seeming for ages.
To better understand the issue of opioid overdoses, an individual has to delve into dynamics of this particular crisis. At the very heart of this particular problem is the fact that the side effects of the drug are not limited to a specific opioid. This, therefore, means drugs ranging from fentanyl patches, hydromorphone as well as oxycodone all have similar effects. Another vital piece of information in regards to opioids is that the opioid tolerance of patients tends to increase over time. In this case, therefore, doses should be administered with respect to the growing bodily tolerance to the drug ((ECRI Institute, 2015).). The opioid crisis is further exacerbated by the fact that opioids are not restricted to hospital settings, their application and use can be found in homes as well as ambulatory care settings. It is also common for individuals to buy these drugs for self-treatment.
Addressing Opioid-related Events
To deal with the opioid challenge, hospitals have had to be innovative and creative in developing appropriate and effective strategies to curb the menace. It takes considerable resources and effort to minimize the issues that arise as a result of opioid misuse. A good example can be found in the prevention and management strategies that were applied by St. Mary's Hospital in Richmond, Virginia. For this particular hospital, the main goal was to minimize the post-operative use of opioids. In realizing this specific goal, the hospital adopted the Bon Secours Richmond Health System (O'Connor, 2017). The new system was launched in August 2016, under the hospitals Enhanced Recovery Program. The main concept of this strategy was to adjust the protocols for patients that were set to undergo open and laparoscopic colorectal surgery.
The strategy begins prior to the surgery and continues after the operation has been completed. Patients are subjected to clear liquids up to two hours before the surgery. They are also provided with nutritional supplements over several days before the surgery. A vital element is remaining the patients to increase the intake of carbohydrates. Upon the completion of the surgery, the hospital strives to ensure that patient diets limit the use intravenous tubes and fluids as well as the use of non-opioid painkillers. The success of this approach is to be found in an 80% reduction in the use of opioids in post-operative situations in over 100 patients that have since undergone colorectal surgery since the inception of the program (O'Connor, 2017). The success of this program hints at the possibility of having narcotic-free prescriptions in the future. More importantly, however, is the understanding how the St. Mary's Hospital came about with this solution.
The hospital was begun by establishing a medication safety committee whose mandate was to help the hospital develop better pain management practices as well as the focus of opioid safety. The committee engaged in activities such as monitoring daily prescriptions on pain management as well as analyzing and evaluating current practices being observed in pain management. This information became vital in helping the hospital to standardize its process of medication reconciliation. The committee was also instrumental in the development of a roadmap of evidence-based best practices in pain management. The success of the St. Mary's program can be attributed to the hospital's ability to stick to guidelines and principles that exist in regards to enhancing quality and patient safety. First in line is the aspect of leadership commitment. In acknowledging the opioid crisis, the management team at the hospital realized the need to act promptly if they were to ensure enhanced quality of care as well as the safety of their patients. This resolve was essential in empowering the staff to actively and continuously contribute to the improvement of quality.
One of the challenges that come with the implementation of new programs is when stakeholders are unaware of the problem that is at hand. In failing to acknowledge the existence of a looming challenge most stakeholders tend to remain lax in their efforts. For St. Mary’s Hospital, this particular obstacle was addressed through stakeholder education. The hospital’s staff was taken through a series of training and workshops aimed at enlightening them on the problem posed by opioids, the impact that it has on the society as a whole, and more essentially how it comes about. It is also worth noting the fact that the hospital’s program was founded on information developed by a multidisciplinary team in the name of a safety committee. This guaranteed that various aspects of the problem would be considered. In abiding by these guidelines, St. Mary's Hospital was able to develop a successful program for its opioid challenge.
Legal and ethical consequences of not addressing opioid use in the healthcare setting
One of the foundational preempts of the medical practice is not to harm. In other words, a medical practitioner is morally obligated to ensure that the decisions they make do not induce physical or psychological harm to the patients. In the incidence of pain management, however, pain management prescriptions are most likely to cause addiction or death in the long run. From a legal perspective, the increasing number of deaths as a result of legally prescribed opioids has created litigation avenues. In other words, families can find a basis for using medical institutions for the loss of their loved ones. It is also important to consider the fact that opioid prescriptions have been linked to addictions. The legal consequences of failing to acknowledge the crisis of opioid use translates to huge economic, moral as well as financial implications to the society at large.
Recommendations Regarding Evidence-Based Interventions to Address Opioid-Related Events
However, several alternatives exist in relation to the enhancement of pain management practices. Monitoring is identified as an essential way of establishing inappropriate opioid prescriptions. This can be achieved by creating platforms that allow hospital pharmacists to send all their prescription information to a centralized system on a daily basis. Alternatively, hospitals can develop stewardship programs that primarily focus on issues of opioids. The success of stewardship programs has numerous examples, beginning with the use of hospital-based antimicrobial stewardship programs to curb the antibiotic resistance crisis. Taking a cue from the significant impact that had been brought by the stewardship program, the Kaweah Delta Medical Centre in Visalia, California, initiated a program that combined physician consultations and opioid stewardship. This particular centre was experiencing a great deal of inappropriate opioid prescriptions, however, upon the implementation of the new program, the hospital experienced a tremendous decline in opioid prescriptions alongside savings amounting to $400,000 (Kim, Nolan, & Ti, 2017).
In other words, by allowing its staff to be trained through stewardship and physician requested a consultation, the hospital managed to ensure that each of its opioid-related cases was being monitored and evaluated for effectiveness and efficiency. Another good example is to be found in the Minneapolis, Minnesota pain medication stewardship program which demonstrated considerable impact on reducing opioid-related events by focusing on pain medication reconciliation. The foundation of any stewardship program is to ensure that a real-time audit and feedback system is in place to cater for any inpatients with opioid prescriptions. The goal in such a case is often to establish any patterns. The importance of stewardship programs is that besides providing point-of-care education, it also allows for physician knowledge improvement which is vital for prudent prescribing practices.
The second recommendation that can be offered in regards to managing opioid-related events is offering pain management and addiction medicine education to hospital staff. An educational system that is entrenched within medical practice entails taking trainees through various teaching hospitals with the goal being to expose them to diverse patient situations that involve pain management. The overall outcome of such lessons is that the trainees will be able to acutely aware of the challenge of opioid overdoses as well as how it can be prevented. Topics to be covered must entail addiction treatment and screening, opioid prescription practices as well as alternatives that are available for pain management. The relevance of education during medical practice is to be found in the argument presented by Mezei et al. this team provides evidence highlighting the fact that only 4% of medical schools in the USA have integrated pain management courses in their curricula (Kim, Nolan, & Ti, 2017).
Technology offers another viable avenue for dealing with the opioid crisis. One way through which technology can be applied in dealing with opioid addiction is by adopting advanced data analytic technology to aid in monitoring opioid prescriptions. The information generated will allow medical practitioners to act upon situations that require immediate attention based on the real-time prescription information. Part of the challenge with the opioid crisis is that patients can manipulate the time-lapse between healthcare facilities in terms of information exchange. However, when the process is automated, prescribers are presented with accurate information regarding opioid prescriptions, and as such, they can address existing problems.
Organizational Barriers to Change and Strategies to Overcome Them
With opioid-related events having been classified as a national crisis, there is a need to adopt urgency in developing solutions and strategies that can be utilized in curbing the issue of opioids. If a significant change is to be noted within the American healthcare system, there is a need to encourage multidisciplinary and multisectoral approaches. Of greater concern, however, is the fact that considerable resistance often characterizes the process of change. Shifting from one system to another often introduces conflict, as a result of a sense of comfort with an existing system or due to strain and effort that comes with adopting a new one. In this case, therefore, the change process is just as a vital as the change that needs to be introduced. In adopting a new system or way of doing things, employees tend to fear issues such as reorganization which translates to new responsibilities (Lachman, Runnacles & Dudley, 2015).
Naturally, a leader initiating such activity tends to be viewed in negative light. In such cases, the employees may attempt to sabotage such a leader by refusing to support the new systems. Such a leader is tasked with the goal of ensuring the hostile staff gets to grasp the significance of switching to a new system. Tremendous resources are thus likely to be spent by the leader in an attempt to re-establish a productive communication channel. Besides draining organizational resources, such efforts also deter the change process by robbing time. Such a leader is advised to utilize peers and team leaders in overcoming such an obstacle. The choice of the peers should be based on their ability to practice and deploy a given methodology. Scepticism has also been widely cited a major obstacle to the change process. Scepticism is often a byproduct of unclear communication. This means that various needs are not being met within the organization.
A leader in such a scenario is expected to conduct a stakeholder analysis which comes in handy in establishing the existing needs and inadequacies of a system. Further on, any problems identified through the analysis should be solved using a team-based approach. By allowing various teams to focus on individual problems, greater efficiency is realized since they have the first-hand experience in their respective areas. Resource shortage is another significant barrier to the change process (Lachman, Runnacles & Dudley, 2015). An organization may lack the sufficient resources to cover the change initiatives, and in the process, it is likely to encounter delays in the change process. In such a case, a leader can opt to outsource the accomplishment of the initial projects with the goal of allowing employees to be trained and mentored. Besides the financial advantage it offers an organization, its importance can also be noted in the role it plays in team morale. As the hired help provide the training, they also complete several projects in the process.
While some change process may be short, some tend to take long periods. Long-term projects tend to diminish commitment to a given project. When the change process has become monotonous, the urgency and energy that may have been invested initially begins to wane, and resistance begins to arise. Effective and robust communication channels are the only solution to such change barriers. This ensures that all levels of the organization are linked and in constant communication. Another way is to use the visible wins that have experienced previously to build momentum within the organization. Ultimately, the best strategy that is effective in combating change barriers is acknowledging the fact that change is hard. This acknowledgement allows a leader to anticipate the challenges that are likely to be encountered. It is from such a position that a solid plan can be developed. The need for a radical shift in regards to pain management should be analyzed from an individual perspective if radical change can be realized. Each person must consider the role they play in the transformation of the healthcare sector, by understanding that the personal decisions influence the overall outcome.
References
ECRI Institute. (2015). Top 10 Patient Safety Concerns for Healthcare 2015 . Retrieved on 12 March 2018, from https://www.ecri.org/EmailResources/PSRQ/Top10/2015_Patient_Safety_Top10.pdf.
Kim, B., Nolan, S., & Ti, L. (2017). Addressing the prescription opioid crisis: Potential for hospital-based interventions? Drug and alcohol review , 36 (2), 149.
Lachman, P., Runnacles, J., & Dudley, J. (2015). Equipped: overcoming barriers to change to improve quality of care (theories of change). Archives of Disease in Childhood-Education and Practice , 100 (1), 13-18.
O'Connor, K. (2017). With new surgical program, Bon Secours reduces opioid use by 80 percent . Retrieved on 12 March 2018, from http://www.richmond.com/life/health/with-new-surgical-program-bon-secours-reduces-opioid-use-by/article_f9477d93-1b81-518d-a091-1b542999d2d3.html.
Vincent, C., & Amalberti, R. (2016). Safer healthcare: Strategies for the real world . Cham: Springer Open.
