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Rural Hospital Driving CSR Abuse Education & Outcomes

Learn how Marion General Hospital is leading the way in CSR abuse education and taking actionable steps to address the issue in their community. Explore their journey, self-evaluations, and prescribing guidelines.

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Rural Hospital Driving CSR Abuse Education & Outcomes

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  1. Rural Hospital Taking Lead in CSR Abuse Educational Efforts & OutcomesAnn Vermilion, MBA, FACHEAdmin. Director Medical Staff Services& Community OutreachMarion General HospitalOctober 29, 2015

  2. Objectives • Demonstrate ways in which a rural hospital can reach outside of the healthcare system to impact controlled substance abuse in one’s community. • Identify hospital data standards to measure progress. • Define steps which can be made within the healthcare system to address community CS abuse.

  3. MGH: Mission for Change STEP #1: Evaluate the CSR abuse: Knowledge is Power • MGH • Grant County • Indiana • USA STEP #2: Investigate “What can we do within our health system?” STEP #3: Implement Prescribing Guidelines STEP #4: Educate - MGH employees, physicians & Community

  4. STEP #1 CSR Abuse: Affects at MGH • Rise in patient requests in ED & Physician Offices • Patient’s disposition and aggressiveness • Climate: threatening, volatile & disruptive = employee and physician dissatisfaction • How are other hospital system's handling?

  5. STEP #1: A Local Epidemic Grant County Drug Court Stats

  6. STEP #1 CSR Abuse: State & National

  7. Where Do Abusers Get Their Drugs? • 55% From friend or relative for free • 11.4% Purchased from friend or relative • 4.8% Took from friend or relative without asking • 4.4% From a drug dealer or stranger • 0.4% Internet • 17.3% From one doctor Source: National Survey Drug Use and Health, Sept. 2011

  8. Community Tactics • Education and Awareness of • Locking up household Rx • Medication Disposal.

  9. Reality Check CSR were entering the streets of our community from Rx written from our medical staff.

  10. STEP #2: Investigate “What can we do within our health system?”

  11. STEP #2: Self Evaluation DETERMINE MEASURABLE DATA • # units of OCCS were administered hospital wide • # of doses of OCCS were administered in ED • % of patients prescribed OCCS • # pills prescribed in ED • # average pills per patient in ED • # of OCCS Rx written in the Primary Care/Specialty Offices

  12. STEP #2: Self Evaluation In 2012-2013 • 27,000 Doses (30,000 tablets) of hydrocodone containing pain reliever • 10,000 Hydromorphone injections • 7,000 Fentanyl injections • 11,000 Morphine injections • Over 63,000 units of OCCS were administered hospital wide • Over 9,600 doses of OCCS were administered in ED • 2,343 (21%) patients prescribed OCCS • 36,400 pills prescribed • 15.5 – average pills per patient • Largest single prescription – Lortab 5-500 #60 for rib fracture • Second largest prescription – Norco 5-325 #40 for toothache

  13. MGH Prescribing Guidelines in the ED • Not to take place of clinical judgment • Provide UNIFORM guidance to emergency care providers • Treat the pain until they could see the referring specialty (3 days vs. 45 days) • Appropriate treatment of acute pain • Appropriate treatment of chronic pain

  14. ED Prescribing Guidelines (cont.) • Attempt to obtain photo ID or patient photograph upon arrival • Once triage complete ALL patients will receive a copy of “Pain Management in our Emergency Department” • Use of INSPECT – 100% employed 80% non-employed • Urine Drug Screen if indicated

  15. MGH Outpatient CSR Rx Guidelines: First Do No Harm The Indiana Healthcare Providers Guide to the Safe, Effective Management of Non-Terminal Pain Recommendations

  16. MGH Journey towards Education Education for area Physicians, MGH Staff & Community July 2012 INSPECT – IN Board of Rx JEAN Team & Judge Spitzer Sept 2013 Howard County Dep. Prosecutor “4 Doctors jailed for Opioid Prescribing Patterns” Jan. 2014 INSPECT – IN Board of Rx for ED team Feb. 2014 MGH Rx Guidelines Education • CME for all ED Staff & Physicians, all medical Practitioners and MGH staff • Service Line meetings (Medical & Surgical) • MGH Primary Care Physicians Meeting • MGH Board of Directors • Community Discussion and Education – 25 local organizations Mar. 2014 5 sessions at MPD yearly officer training

  17. Communication Timeline • Community Roundtable – Feb. 25, 2014 • Law Enforcement Agencies • Healthcare Providers • JEAN Team • Grant Co. Courts and Prosecutor’s Office • Local Pharmacies • Substance Abuse Treatment Providers • Social Services • Medical Providers • Grant County Health Department

  18. Community Support a Priority Our mission to provide a safer community is supported by:

  19. STEP #3 MGH OOCS (Opioid & Other Controlled Substances) Prescribing Guidelines Launched APRIL 1, 2014

  20. How are we doing in Grant County: 1 year later? STEP #5: Evaluate and Awareness

  21. > 64,900 pills

  22. Estimated decrease in Pills > 64,900 pills in MGH ED @ 34,000 pills in MGH Inpatient DC & Physician Practices @ 100,000 pills in one year

  23. Monitoring Addictive Behaviors in Grant Count: Changes in Drug of Choice

  24. Total since 2013 = 53 Repeat patients = 6

  25. Narcan Use – Reversal Agent for Opioid Overdose • EMS started administering intra-nasal Narcan June of 2014 • EMS administered Narcan 56 times in 2014 (beginning in June) Average 8 per month • EMS 2015 Year-to-Date has administered Narcan 89 times (average 10 per month) Jan to May Estimated 96 annualized June to Dec = 56 118 annualized Jan to Sept = 89 Oct to Dec Estimated

  26. MGH Data • Age breakout • ISDH confirmed • Notes: • MGH data: Preliminary cases, labs we report to ISDH. • Does not deduct transmission or contracted through intravenous drug use. • May not be newly diagnosed, but new to our system.

  27. JEAN TeamDrug Task Force Statistics

  28. Continuous Education • Rise in Heroin – Community Task Force for Evaluation -Held July/August • CME offerings - Presentation – 1 year later - Climate of Heroin abuse

  29. Heroin Task Force September 29, 2015 Broke into Committees: 1. Data Collection 2. Public Health Response • Education, Outreach & Communication • Grant county resources available 3. Syringe Exchange Program (Logistics)

  30. Meet Some of my Team Members • Tammy Cornelious, RN Administrative Director MGH Emergency Department • John Kauffman, Detective Sargent, Marion Police Dept, JEAN Team Joint Effort Against Narcotics • Mark Spitzer, Judge of Grant Superior Court 3 • Steve Kroh, PharmD Local Pharmacist

  31. Our mission to provide a safer community is supported by: Roundtable Discussion & Questions • Are your communities seeing similar climates? • Were your physicians interested in education on INSPECT, CSR abuse, Heroin rise? • Obstacles and Opportunities?

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