In addition to handouts, pictures, and other forms of educational messaging, The Everett Clinic standardized the clinical
practice of acute pain management within its walk-in clinics.
This tactic to decrease unnecessary variation proved successful, and they were able to reduce the prescription rate of
opioids by 45%.
The Everett Clinic also placed a focus on orthopedic surgery. To
drive down unnecessary variation in this setting, they developed
an acute pain pathway, hardwired initial prescriptions and refills,
and developed a standard taper for all patients. In 16 months’
time, The Everett Clinic experienced a 67% decline in the number
of chronic opioid therapy (COT) patients in orthopedic surgery.
Compliance and Best Practice
In addition to these new pain-management protocols, The
Everett Clinic recognized that if it was going to successfully
ensure patient safety, it needed to focus on opioid best practice guidelines and state regulations. A key first step was to
develop an organizational policy and procedure.
“Guidelines are optional,” said Dr. Chamblin. “A policy is not
optional. And our policy was developed based on the Washing-
ton state law.”
Leveraging the entire care team became a key factor in this
process. For example, The Everett Clinic developed standard
workflows for medical assistants and receptionists to help
providers maintain best practices. They explained that these
can be time-consuming for the provider. Organizations can
and should make this a team effort.
The Everett Clinic also succeeded in making its data trans-
parent. Actionable data dashboards were designed at all levels
Probability of Continued Opioid
Use after First Prescription
of management. These are readily visible to all
the entire care teams. As a result of these measures, the organization has been able to increase
the compliance of its Comprehensive Pain Center
to 92% and its primary care to 80%, achieving
14% and 47% increases, respectively.
Identifying Patients at High
Risk of Overdose and Death
The Everett Clinic recognized that opioids have
measurable risk for adverse events. The challenge
comes in identifying those patients at highest
risk for overdose, and then mitigating that risk.
“We currently have just more than 4,000
patients on chronic opioid therapy,” said Dr. Hu.
“That is a big number, and we wanted to try to fig-
ure out which ones of those patients were most
likely to have a complication.”
Last year, The Everett Clinic identified mul-
tiple groups of high-risk patients: patients on
high doses, patients with concurrent use of
benzodiazepines, and patients who experienced
overdose events. The Everett Clinic identifies those patients
and communicates directly with the prescribers. There is
then a process of reassessment of the patient’s chronic pain,
tapering of their prescription, the use of naloxone, or a referral
to the Pain Clinic. Over 16 months, there was a 68% decline
in the number of COT patients with a high morphine equiva-
lent dose (MED) (a MED greater than 120) in primary care. The
organization also saw a 23% decline in the number of patients
with both opioids and benzodiazepines.
When it came to prescription opioid overdose events, The
Everett Clinic collaborated with the local hospital and emergency department to develop patient reports of possible
overdose events. The medical group validates the information
to identify patients who have had a prescription opioid overdose and communicates that information directly with the
prescribers, adding a problem list entry and an alert in the
EMR for any future opioid prescribing.
The Everett Clinic continues to refine and advance its
approach to opioid safety. It is a journey. And Drs. Hu and
Chamblin recognize that there are many opportunities for
their continued focus on opioid safety.
“The last question is really: what will you do next?” asked Dr.
Hu. “There are lots of different opportunities. What will you do
differently on Monday, when you go back to your organization?”
Kent Hu, M.D., M.P.H., is associate medical director of quality and
patient safety, and Dianna Chamblin, M.D., is facility medical director, Comprehensive Pain Center, The Everett Clinic.
5 10 15 20 25 30 35 40 45
Days’ supply of first opioid prescription