we’ve been tracking these statistics for many, many years
and been aware. We knew that we had to do something to
improve our opioid prescribing and improve the safety for our
patients. But the motivation really came when we recognized
that these were our patients. These were our patients who
are dying, our patients who are suffering from excess morbidity and mortality. Why? Because of the medications that
we prescribed. This is not a statistic. This is not a number.
These are our patients.”
The Opioid Epidemic
Drs. Hu and Chamblin explained that, according to 2016
national statistics, 11. 5 million people misused prescription
opioids that year. Of the more than 42,000 people who died
from overdosing on opioids, over 17,000 of those deaths were
attributed to overdosing on commonly prescribed opioids,
with over 19,000 attributed to synthetic opioids (Figure 1).
According to the National Institutes of Health, in 2018, 80%
of people who use heroin first misused prescription opioids.
Beyond the mortal cost of the opioid epidemic, the economic
cost of battling this issue has reached over $504 billion.
“It’s almost ironic that we have to talk about having a patient
safety focus because, after all, we went into health care to
help patients,” said Dr. Hu. “And yet, what we’ve
recognized over many decades is that medicine is
dangerous. So we have a collective responsibility
to shepherd our patients through our clinics in
the safest possible way.”
Patient Safety Assessment
Dr. Hu asserts that before organizations can
improve, they first need to measure and understand their baseline performance. The Everett
Clinic performed a self-evaluation in 2012 and
recognized opportunities for improvement.
“We didn’t have the tools in place, we didn’t
have the culture in place,” said Dr. Chamblin.
Providers didn’t have sufficient data, had difficulty keeping up with changing guidelines, and
expressed challenges with the difficult conversations with their patients.
Drs. Hu and Chamblin recognized the impor-
tance of ensuring a culture of safety to handle
the challenges to opioid practice improvement.
“Culture is the sum total of our knowledge, actions,
and beliefs,” said Dr. Hu. “It’s the collective behav-
iors and social norms of an organization. And so,
really acknowledging your culture and actively
managing it is the most important lever you have
to improving patient safety. Whether or not it’s for
opioids or for any other patient safety initiative,
once you address culture, then systems can be
built to make it easy for providers and their front-
line teams to do the desired behaviors.”
One of the most fundamental tactics to change culture and
reinforce desired behaviors is to bring providers and staff back
to the “why” of an organization’s purpose. In the case of opioid
patients, The Everett Clinic chose to share patient stories
as a method to change culture. This puts a face to the num-
bers and meaning to the statistics. As a result, opioids have
become The Everett Clinic’s No. 1 patient safety priority.
When and When Not to Prescribe
With a clear mission to improve opioid safety, The Everett
Opioid Epidemic by the Numbers, 2016
Clinic implemented three strategies: ( 1) appropriate pain
control, ( 2) safe opioid prescribing, and ( 3) identification/
management of high-risk, chronic opioid patient groups.
Among the messaging The Everett Clinic shares with its
providers is that opioids are to be used only when necessary.
“Opioids have a role,” said Dr. Chamblin. “There’s no question
opioids have a role, but they don’t have a role in many of the
conditions where they have been commonly used.”
The key process has been educating patients, families,
and prescribers about alternatives to opioids. The latest data
shows that even a small initial prescription of opioids can
pose significant risks of addiction to patients (Figure 2).