Pardee Innovative Practice Interview

July 6, 2017

Health Innovations in Our Community

WCMS’ Cutting Edge highlights WNC physicians, practices and programs that are on the cutting edge of health care transformation, both big and small. WCMS supports local physician members who are change agents by recognizing them and sharing among other WCMS members and the general community information about these local innovations. If you know of such a physician or practice, please contact Miriam Schwarz.

Pardee Hospital physicians, Dr. David Ellis, MD (Chief Medical Officer) and Dr. Scott Donaldson, MD (Chief of Staff) were interviewed on May 23rd with regard to the hospital’s actions to tackle the opioid crisis.

1. What innovations are being implemented by Pardee to address the opioid epidemic?

Dr. Donaldson: At Pardee UNC Health Care, we believe it is crucial to have an appropriate response to the opioid epidemic, as all hospitals and health care providers are struggling to combat the issue. We have launched a pilot program using a personal narcotic deactivation bag called Deterra. This allows patients to destroy leftover narcotics after hospitalization, outpatient surgery, or acute pain — such as trauma — that requires such medication. This decreases the amount of leftover narcotics that might ultimately reside in someone’s medicine cabinet. We also have a committee within the hospital composed of doctors, pain management specialists, nurses, and administration to develop comprehensive narcotics/opioid prescribing policies for Pardee. We are looking at the current prescribing practices of our physicians and identifying areas of over-prescribinng.

Dr. Ellis: What initially has to happen is that doctors need to recognize there is a problem. That is not a given. A surgeon who has been practicing for 15 years may believe that they’ve never had an addicted patient, but there is no way to really know this or to track it. It’s a challenging cultural change for a health care organization, so we’re working on opening the lines of communication about the issue.

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2. What were the reasons that you launched these innovations?

Dr. Donaldson: We launched these innovations to decrease the excess number of opioids prescribed and decrease the amount left over after an event requiring such medication. Leftover medication is always at risk for diversion, or inappropriate use.

Dr. Ellis: We’re in the infancy stages of figuring out how to have fewer narcotics leaving the hospital overall and what to do with the ones left over.

3. What key lessons did you learn along the way? What has yielded positive results? What are the weaknesses?

Dr. Ellis: We are continuing to learn and think about different ways of achieving these goals. The Deterra bags are approximately $1.79 each, so we want to be sure they are appropriately distributed in a fashion that ensures greatest compliance. We found that giving them out at the time of discharge from outpatient surgery resulted in approximately 50% usage. We are curious whether the percentage might increase if they are distributed through doctors’ offices at the time of post-op visits — after the patient theoretically has no more use for the medication.

Dr. Donaldson: We’ve also learned that it is a continuous challenge trying to communicate new policies, procedures and ideas to the hospital staff, particularly contract employees who may be working with us on a temporary basis. To effectively change prescribing procedures, it’s best to have constant communication with staff. As a result, it can be easier to implement change with employed staff and more difficult with temporary staff. We need all staff to buy in to the procedural changes and it can be tough to get everyone on the same page.

4. What are the impacts/outcomes of the innovation?

Dr. Donaldson: We hope the outcome of all of these efforts would be less overall prescribing of narcotics from the providers at Pardee and that there would be a lower amount of leftover medication available for diversion. Organizationally, we want to recognize the problem and hope other organizations catch on.

Dr. Ellis: It’s a long hill to climb. We have to recognize that it took approximately one generation for us to arrive in the current situation and it might take that long to remove ourselves. However, it’s an effort worth making and we are committed to seeing it through.

5. In what ways does this innovation improve the physician-patient relationship?

Dr. Donaldson: Part of advocating for our patients is telling them what they may not want to hear, even if it is best for their health. We need to emphasize to our patients that, realistically, recovery will not be entirely pain-free. Feeling some physical pain is a part of any recovery, and we should not prescribe opioids to make patients 100 percent pain-free.

Dr. Ellis: We found that patients were quite appreciative of the disposal bags and thought it was a good idea both for them and for the community at large.

5. Are there opportunities to collaborate with other organizations in WNC?

Dr. Ellis: The beginning of collaboration is recognition of the problem and the determination to do something about it. There has to be an understanding and acceptance that, while physicians have been under undue pressure to treat pain up until now, for these and other reasons, physicians have not been part of the solution to this problem. As physicians, we must have a loud, clear voice about this issue.

Dr. Donaldson: I see a great potential for collaboration with small, local organizations. We need influential community members to be active on this issue.

6. What advice would you give to others interested in implementing your innovation?

Dr. Donaldson: It’s difficult to get everyone on the same page, especially in the age of temporary and contract staff. The key is consistent communication about the issue.

Dr. Ellis: There needs to be a buy-in from doctors, nurses and administrators. Try to find people who have a passion for resolving the issue. You need a team who can drive the new prescribing processes and provide practical solutions.