Ten ERs In Colorado Tried To Curtail Opioids And Did Better Than Expected

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Sun Mar 25 11:29:43 PDT 2018



February 23, 2018


Ten ERs In Colorado Tried To Curtail Opioids And Did Better Than Expected



pYkcLzwX85EAFIfnmD4FuCRvNJzPGpJJ5s&_hsmi=60899000> Kaiser Health News



By John Daley


DENVER - One of the most common reasons patients head to an emergency room
is pain. In response, doctors may try something simple at first, like
ibuprofen or acetaminophen. If that wasn't effective, the second line of
defense has been the big guns.


"Percocet or Vicodin," explained ER doctor Peter Bakes of Swedish Medical
Center, "medications that certainly have contributed to the rising opioid


Now, though, physicians are looking for alternatives to help cut opioid use
and curtail potential abuse. Ten Colorado hospitals, including Swedish in
Englewood, Colo., participated in a six-month pilot project designed to cut
opioid use, the Colorado Opioid Safety Collaborative. Launched by the
Colorado Hospital Association, it is billed as the first of its kind in the
nation to include this number of hospitals in the effort.


The goal was for the group of hospitals to reduce opioids by 15 percent.
Instead, Dr. Don Stader, an ER physician at Swedish who helped develop and
lead the study, said the hospitals did much better: down 36 percent on


"It's really a revolution in how we approach patients and approach pain, and
I think it's a revolution in pain management that's going to help us end the
opioid epidemic," Stader says.


The decrease amounted to 35,000 fewer opioid doses than during the same
period in 2016.


The overall effort to limit opioid use in emergency departments is called
the Colorado ALTO Project; ALTO is short for "alternatives to opioids."


The method calls for coordination across providers, pharmacies, clinical
staff and administrators. It introduces new procedures, for example, like
using non-opioid patches for pain. Another innovation, Stader said, is using
ultrasound to "look into the body" and help guide targeted injections of
non-opioid pain medicines.


Rather than opioids like oxycodone, hydrocodone or fentanyl, Stader said,
doctors used safer and less addictive alternatives, like ketamine and
lidocaine, an anesthetic commonly used by dentists.


Lidocaine was by far the leading alternative; its use in the project's ERs
rose 451 percent. Ketamine use was up 144 percent. Other well-known
painkillers were used much less, like methadone (down 51 percent), oxycodone
(down 43 percent), hydrocodone (down 39 percent), codeine (down 35 percent)
and fentanyl (down 11 percent).


"We all see the carnage that this opioid epidemic has brought," Stader said.
"We all see how dangerous it's been for patients, and how damaging it's been
for our communities. And we know that we have to do something radically


Claire Duncan, a clinical nurse coordinator in the Swedish emergency
department, said the new approach has required intensive training. And there
was some pushback, more from patients than from medical staff.


"They say 'only narcotics work for me, only narcotics work for me.' Because
they haven't had the experience of that multifaceted care, they don't expect
that ibuprofen is going to work or that ibuprofen plus Tylenol, plus a
heating pad, plus stretching measures, they don't expect that to work," she


The program requires a big culture change, encouraging staff to change the
conversation from pain medication alone to ways to "treat your pain to help
you cope with your pain to help you understand your pain," Duncan said.


Emergency medical staff are all too familiar with the ravages of the opioid


They see patients struggling with the consequences every day. But Bakes, the
ER doctor at Swedish, said this project has changed minds and allowed health
care professionals to help combat the opioid crisis they unwittingly helped
to create.


"I think that any thinking person or any thinking physician, or provider of
patient care, really felt to some extent guilty, but . powerless to enact
meaningful change," Bakes said.


The pilot project has proven so successful that Swedish and the other
emergency departments involved will continue the new protocols and share
what they learned. Stader said the Colorado Hospital Association will help
spread the word about opioid safety and work toward its adoption statewide
by year's end.


"And I think if we did put this in practice in Colorado and showed our
success that this would spread like wildfire across the country," Stader


The 10 hospitals that collaborated on the project include Boulder Community
Health, Gunnison Valley Health, Sedgwick County Health Center, Sky Ridge
Medical Center, Swedish Medical Center, UCHealth Greeley Emergency and
Surgical Center, UCHealth Harmony Campus, UCHealth Medical Center of the
Rockies, UCHealth Poudre Valley Hospital and UCHealth Yampa Valley Medical




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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