OrthoSpineNews.com spoke to Todd J. Albert, MD, Surgeon-in-Chief Emeritus at HSS, and Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, to discuss how HSS has decided to tackle the issue of opioid prescribing.

Dr. Albert explained, “There are gaps and inconsistencies in physicians’ knowledge regarding opioid prescribing. We at HSS realized this early on and in 2016 we created an education program for our healthcare providers and demanded 100 percent participation.” We then launched into developing service-specific guidelines and simultaneous studies on what exactly was being prescribed, and developed guidelines to help patients dispose of unused opioids appropriately, he added.

Dr. Waldman cited, “Opioid prescribing can have dangerous consequences, and at our institution we made a conscious decision to do what we could to minimize the individual variability between clinicians. It is no longer acceptable to write a prescription without details on why this patient needs a certain medication and dose, as well as the plan for how she or he will be safely tapered off the medication. We require all our prescribers to establish an opioid contract with their patients...and our electronic health record (EHR) notifies the clinician when it is time to renew it. In addition, when necessary, we provide individual coaching for prescribers who need help discussing opioid treatment with their patients.”

Dr. Waldman advised, “Those who wish to implement similar programs at their own institution should know that the first and most important thing you have to change is the culture of the hospital itself. At HSS, opioid stewardship is everyone’s responsibility. Surgeons want the best outcomes for their patients and wouldn’t bring someone with a complex pain problem to the OR without the evaluation and treatment of a pain specialist, any more than they would ignore the preoperative recommendations of a cardiologist. If you want to effectuate this kind of change at your facility, get your administrators and surgeons on board.”

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