Weiner Scott G, Price Christin N, Atalay Alev J, Harry Elizabeth M, Pabo Erika A, Patel Rajesh, Suzuki Joji, Anderson Shelly, Ashley Stanley W, Kachalia Allen
Jt Comm J Qual Patient Saf. 2019 Jan;45(1):3-13. doi: 10.1016/j.jcjq.2018.07.003. Epub 2018 Aug 28.
The opioid overdose crisis now claims more than 40,000 lives in the United States every year, and many hospitals and health systems are responding with opioid-related initiatives, but how best to coordinate hospital or health system-wide strategy and approach remains a challenge.
An organizational opioid stewardship program (OSP) was created to reduce opioid-related morbidity and mortality in order to provide an efficient, comprehensive, multidisciplinary approach to address the epidemic in one health system. An executive committee of hospital leaders was convened to empower and launch the program. To measure progress, metrics related to care of patients on opioids and those with opioid use disorder (OUD) were evaluated.
The OSP created a holistic, health system-wide program that addressed opioid prescribing, treatment of OUD, education, and information technology tools. After implementation, the number of opioid prescriptions decreased (-73.5/month; p < 0.001), mean morphine milligram equivalents (MME) per prescription decreased (-0.4/month; p < 0.001), the number of unique patients receiving an opioid decreased (-52.6/month; p < 0.001), and the number of prescriptions ≥ 90 MME decreased (-48.1/month; p < 0.001). Prescriptions and providers for buprenorphine increased (+6.0 prescriptions/month and +0.4 providers/month; both p < 0.001). Visits for opioid overdose did not change (-0.2 overdoses/month; p = 0.29).
This paper describes a framework for a new health system-wide OSP. Successful implementation required strong executive sponsorship, ensuring that the program is not housed in any one clinical department in the health system, creating an environment that empowers cross-disciplinary collaboration and inclusion, as well as the development of measures to guide efforts.
阿片类药物过量危机目前在美国每年导致超过40000人死亡，许多医院和医疗系统正在通过与阿片类药物相关的举措做出应对，但如何最好地协调医院或全医疗系统的策略和方法仍是一项挑战。
创建了一个组织性阿片类药物管理计划（OSP）以降低与阿片类药物相关的发病率和死亡率，从而提供一种高效、全面、多学科的方法来应对一个医疗系统中的这一流行病。召集了一个由医院领导组成的执行委员会来推动并启动该计划。为衡量进展情况，对与阿片类药物使用患者及阿片类药物使用障碍（OUD）患者护理相关的指标进行了评估。
OSP创建了一个全医疗系统的整体计划，该计划涉及阿片类药物处方、OUD治疗、教育及信息技术工具。实施后，阿片类药物处方数量减少（-73.5/月；p<0.001），每张处方的平均吗啡毫克当量（MME）下降（-0.4/月；p<0.001），接受阿片类药物治疗的独特患者数量减少（-52.6/月；p<0.001），且≥90 MME的处方数量减少（-48.1/月；p<0.001）。丁丙诺啡的处方和开处方者增加（+6.0张处方/月和+0.4名开处方者/月；均p<0.001）。阿片类药物过量就诊次数未改变（-0.2次过量/月；p = 0.29）。
本文描述了一个新的全医疗系统OSP框架。成功实施需要强有力的行政支持，确保该计划不隶属于医疗系统中的任何一个临床科室，营造一个能促进跨学科协作与包容的环境，以及制定指导工作的措施。
