Data and Metrics

Doug Oyler, PharmDPhillip Chang, MD

UK HealthCare

Opioid Stewardship Metrics

GENERAL OPIOID USE

Daily MMEOpioid-free patients

Opioid-free daysOpioid continuation

Opioid cessation

HIGH RISK USE

Opioids + benzosOver 50/90 MMENew start opioids

ER/LA products

SAFETY

Naloxone useOpioid-ADEPOSS Scores

Naloxone co-Rx

PAIN CONTROL

Pain scoresHCAHPS

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UK HealthCare

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• Guidance regarding metrics

• Nineteen metrics in four key domains1. Pain management (8 metrics)

2. Discharge (6 metrics)

3. Patient outcomes (3 metrics)

4. Patient assessment (2 metrics)

Rizk E, Swan JT, Cheon O, et al. Am J Health-Syst Pharm 2019;76:225-35.https://academic.oup.com/ajhp/article-abstract/76/4/225/5305707

Opioid Stewardship Metrics

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Rizk, et al. Am J Health-Syst Pharm. 2019; 76:225-35

PAIN MANAGEMENT

Duplicate PRNER/LA products

Daily MMEOpioids + sedating drugs

Daily dose ≥ 90 MMEDocumented pain planDaily dose ≥ 50 MME

IVP opioid

DISCHARGE

Rx > 7 daysRx ≥ 50 MME/dayED Rx > 3-5 days

Education providedED d/c with opioid

Hosp. d/c with opioid

PATIENT OUTCOMES

Naloxone usePOSS ≥ 3

Severe pain ratings

PATIENT ASSESSMENT

Documented pain goalsDocumented function

goals

KY SOS Standards

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1. Safe opioid prescribing is an organizational priority. Metric 1

2. Prescribers of opioids (e.g., MDs, APRNs) within the organization are aware of best practices and legal regulations surrounding safe opioid use. Metrics 2a, 2b.

3. The organization uses evidence-based nonopioid analgesic regimens in the emergency department (e.g., ALTO). Metric 3

4. The organization uses evidence-based opioid-sparing analgesic regimens for ambulatory procedures (e.g., ERAS). Metrics 4a, 4b, 4c

5. The organization offers compassionate care to patients with OUD. Metric 5

6. The organization provides nonpharmacologic analgesia. Metric 6

7. The organization promotes safe opioid use by patients. Metric 7

8. The organization collaborates with community partners (e.g., clinics, home-based care, pharmacies, law enforcement, religious organizations, and government agencies) to promote appropriate use of opioids in the community. Metric 8

1. Safe opioid prescribing is an organizational priority.

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Rationale: To ensure success, opioid stewardship programs must have support from senior hospital leadership.

Reporting Metric(s): Signed commitment letter to KY SOS.

2. Prescribers of opioids within the organization are aware of best practices and legal ramifications surrounding safe opioid use

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Rationale: Opioids are most commonly accessed through the healthcare system. Even when used appropriately, opioids carry risks, and providers and health systems should be aware of these risks for appropriate action.

Reporting Metrics:

𝐴𝑑𝑢𝑙𝑡 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑟𝑒𝑞𝑢𝑖𝑟𝑖𝑛𝑔 𝑛𝑎𝑙𝑜𝑥𝑜𝑛𝑒 𝑎𝑓𝑡𝑒𝑟 𝑜𝑝𝑖𝑜𝑖𝑑 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑟𝑎𝑡𝑖𝑜𝑛

𝐴𝑑𝑢𝑙𝑡 𝑖𝑛𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠

𝐴𝑑𝑢𝑙𝑡𝑠 𝑑𝑖𝑠𝑐ℎ𝑎𝑟𝑔𝑒𝑑 𝑤𝑖𝑡ℎ 𝑑𝑢𝑝𝑙𝑖𝑐𝑎𝑡𝑒 𝑜𝑝𝑖𝑜𝑖𝑑 𝑜𝑟 𝑜𝑝𝑖𝑜𝑖𝑑 & 𝑏𝑒𝑛𝑧𝑜𝑑𝑖𝑎𝑧𝑒𝑝𝑖𝑛𝑒 𝑅𝑥

𝐴𝑑𝑢𝑙𝑡 𝑑𝑖𝑠𝑐ℎ𝑎𝑟𝑔𝑒𝑠

3. The organization uses evidence-based nonopioid analgesic regimens in the emergency department (e.g., ALTO).

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Rationale: Few conditions account for most acute pain ED visits, and guidelines for nonopioid analgesia are well established.

Reporting Metric:

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑛𝑜𝑡 𝑔𝑖𝑣𝑒𝑛 𝑜𝑝𝑖𝑜𝑖𝑑 𝑖𝑛 𝐸𝐷 𝑓𝑜𝑟 𝑝𝑎𝑖𝑛𝑓𝑢𝑙 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑖𝑛 𝐸𝐷 𝑓𝑜𝑟 𝑝𝑎𝑖𝑛𝑓𝑢𝑙 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛

4. The organization uses evidence-based opioid-sparing analgesic regimens for ambulatory procedures (e.g., ERAS).

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Rationale: Multimodal analgesic strategies have been shown to improve numerous outcomes for multiple procedures.

Reporting Metrics:

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑔𝑖𝑣𝑒𝑛 ≤ 3 𝑑𝑎𝑦𝑠 𝑜𝑓 𝐶𝐼𝐼 𝑜𝑝𝑖𝑜𝑖𝑑 𝑓𝑜𝑟 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑎

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑢𝑛𝑑𝑒𝑟𝑔𝑜𝑖𝑛𝑔 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑎

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑔𝑖𝑣𝑒𝑛 ≤ 3 𝑑𝑎𝑦𝑠 𝑜𝑓 𝐶𝐼𝐼 𝑜𝑝𝑖𝑜𝑖𝑑 𝑓𝑜𝑟 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑏

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑢𝑛𝑑𝑒𝑟𝑔𝑜𝑖𝑛𝑔 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑏

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑔𝑖𝑣𝑒𝑛 ≤ 3 𝑑𝑎𝑦𝑠 𝑜𝑓 𝐶𝐼𝐼 𝑜𝑝𝑖𝑜𝑖𝑑 𝑓𝑜𝑟 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑐

𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑢𝑛𝑑𝑒𝑟𝑔𝑜𝑖𝑛𝑔 𝑎𝑚𝑏𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑝𝑟𝑜𝑐𝑒𝑑𝑢𝑟𝑒 𝑐

5. The organization offers compassionate care to patients with opioid use disorder.

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Rationale: Patients with opioid use disorder should be identified and have comprehensive care offered or arranged when accessing the health system.

Reporting Metric(s): Presence of referral process (survey), availability of medication assisted therapy on hospital formulary (survey)

6. The organization provides nonpharmacologic analgesia.

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Rationale: Nonpharmacologic analgesia is recommended by multiple agencies, including CDC, as first line therapy for many painful conditions.

Reporting Metric(s): Presence of nonpharmacologic therapies (survey).

7. The organization promotes safe opioid use by patients.

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Rationale: Safe opioid use begins with management of expectations, patient empowerment, and patient education.

Reporting Metric(s): Educational materials designed for patients receiving opioids in the hospital and/or upon discharge.

8. The organization collaborates with community partners (e.g., clinics, home-based care, pharmacies, law enforcement, religious organizations, and government agencies) to promote appropriate use of opioids in the community.

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Rationale: In many settings, healthcare facilities are community leaders for education, outreach, and awareness.

Reporting Metric(s): Presence of community outreach (survey).

Reporting Metrics –Summary

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Standard Associated Reporting Metric(s)

1. Organizational priority 1 – Commitment Letter

2. Prescriber education2a – Opioid-Related Harm

2b – Concurrent Prescribing

3. ED program 3 – ED Prescribing

4. Postoperative program

4a – Postoperative Prescribing (procedure 1)

4b – Postoperative Prescribing (procedure 2)

4c – Postoperative Prescribing (procedure 3)

5. Compassionate OUD care 5 – Survey Response

6. Nonpharmacologic treatment 6 – Survey Response

7. Safe opioid use 7 – Educational materials

8. Community outreach 8 – Survey Response

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Thank You