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News & Events

New opioid misuse prevention guidelines

06/22/2018

The Massachusetts Health & Hospital Association (MHA) and Tufts Medical Center, working with hospital clinicians and operational staff in Massachusetts and other states, have developed two documents to help hospitals develop internal policies to prevent opioid misuse by patients admitted for care and treatment. The new Inpatient Opioid Misuse Prevention Guidelines and Patient and Family Agreement on Opioids are now available on MHA’s PatientCareLink website.

Current opioid epidemic

“Our nation’s opioid epidemic has become the great equalizer. No zip code, no income level, no background, is immune from its devastating reach. It will take all of our best and collective efforts to solve this complex problem that has already taken far too many lives. Hospitals on the front lines of this battle are committed to using our resources and expertise to develop and effect solutions.  We’ve led the way on implementing prescription limits, which is beginning to make a significant difference in reducing access to opioids,” said Steve Walsh, President & CEO of MHA. “We are gravely concerned knowing that addicted patients bring heroin or non-prescribed opioids with them to the hospital, or try to obtain illegal drugs during their stay.  Today, we announce a new component in our initiative to prevent unlawful and dangerous opioid use within hospitals. We are working in tandem with our member hospitals and other concerned groups to launch inpatient guidelines and a patient/family agreement to provide a first-in-the-nation, comprehensive, statewide framework to screen, manage, and treat patients with Opioid Use Disorder (OUD).”

“How we manage this epidemic inside our hospitals is of utmost importance. Hospitalized individuals with Opioid Use Disorder (OUD) are at increased risk of leaving against medical advice, suffering painful withdrawal symptoms, and dying from an overdose post-discharge if their tolerance for opioids goes down during hospitalization,” said Deeb Salem, MD, Tufts Medical Center co-interim CEO and chair of the Department of Medicine at Tufts University School of Medicine. Dr. Salem co-authored the documents with Steven Defossez, MD, MHA’s Vice President for Clinical Integration, 
Tufts University School of Medicine student Ifeanyi D. Chinedozi, and Tufts University student Megan V. Fernandez, now at University of Massachusetts Medical School.

“We want to assist hospital-based clinicians to care for patients with Opioid Use Disorder (OUD) with both evidence-based best practices and compassion,” Dr. Defossez said. 

New guidelines

The Inpatient Opioid Misuse Prevention Guidelines identify best practices (clinical practices and operational policies) to optimize patient care. These include specific instructions regarding:

  • Screening for opioid use disorder among patients admitted for inpatient level care;
  • Prevention of inpatient acute opioid withdrawal through medication assisted therapy;
  • Prevention of and response to an opioid overdose ;
  • Management of acute pain in the setting of chronic opioid use;
  • Preventing patients from bringing opioids into a hospital ;
  • Working with visitors to prevent inappropriate opioid use or bringing in opioids during visitation;
  • Educating patients on the risks of opioid misuse;
  • Security de-escalation; and
  • Care coordination for patients refusing to follow zero-tolerance of opioid misuse.

The Patient and Family Agreement on Opioids was written specifically for patients, families, and visitors. It states that the care team is committed to the patient’s recovery and wellness, and that facilities offer patients options to assist them on their road to recovery.  This includes medications to keep them from going into withdrawal while they are hospitalized as well as assistance in finding available services following their discharge, if they so choose. The document also spells out the obligations of a patient’s family and visitors to help achieve this goal, including a patient-centered zero tolerance for inpatient opioid misuse. Included in the document are a template consent form for the OUD patient to sign and a separate template consent form for family members and visitors of patients suffering from OUD. 

The latest opioid guidance builds on efforts from MHA and the hospital community to curb the opioid crisis. Previously, MHA convened a task force that included a multi-disciplinary group of clinicians and operational staff to develop and issue an array of guidance and informational sheets to help improve opioid prescribing practices within hospitals.  The materials also provide standards for screening patients seeking opioid prescriptions, offer information on appropriate pain management and treatment, and help identify resources for patients needing substance use disorder treatment. The materials include patient and provider fact sheets about the risk and harm of opioids, suggestions for the proper storage and disposal of opioids, and suggestions on improving internal education of clinicians to help them limit and find alternatives to using opioid pain medications.   All of these materials, as well as this recent set of guidance documents, are available on the MHA’s PatientCareLink website.

Learn more about the Parent and Family Agreement >