Preventing Opioid Overdoses and Death: Let’s Start in the Hospitals

Co-written by Michael Wong, JD, with Arielle Bernstein Pinsof, MPP, Finn Partners and Gil Bashe, Managing Partner, Finn Partners Health Practice

In the clinical setting, overdoses are preventable as the full range of interventions is at hand.

The tragedy of our national opioid epidemic has gripped hearts and headlines for months now with heartbreaking personal stories, images and statistics. But the truth is, not all overdose deaths are taking place on the streets — so while physicians and lawmakers race to find interventions that work on the front lines in our communities, shouldn’t we also take concrete steps to reduce opioid overdoses in the clinical setting — where they are highly preventable — where the full range of interventions are at hand?

According to the National Institutes of Health (January 2019), more than 130 people in the United States die after overdosing on opioids every day. Among these deaths are patients in the hospital setting, recovering from surgical procedures or undergoing sedation, who are often prescribed opioids such as morphine and oxycodone to manage pain — a necessity for healthy and comfortable recovery. But at certain doses, these drugs can also cause respiratory failure, and, because each patient is different, there is no one dose that is “right” or “wrong.”

That’s where patient monitoring takes on an essential life-or-death function.

According to the Association for the Advancement of Medical Instrumentation (AAMI) Foundation, 50 percent of medication deaths are attributable to opioids and each year more than 20,000 patients administered opioids experience respiratory depression arrests — costing the U.S. healthcare system $2 billion each year.

Hospitals must take action to ensure their staff are aware of these risks, and to put protocols in place to prevent the unthinkable.

• Periodic checks are not enough. Current monitoring procedures, which consist of periodic in-person checks by nurses and doctors on duty, can leave patients un-monitored up to 96 percent of the time. However, since opioid-induced respiratory depression can occur in a matter of minutes, relying on periodic checks is woefully insufficient.
• Don’t penalize hospitals for opioid-related readmissions. Under Medicaid and Medicare policies, hospitals that readmit patients with the same medical condition are forced to bear the economic burden of opioid-related re-admissions. One Illinois-based hospital offering inpatient and outpatient addiction therapy treated some 2,000 patients for opioid-related conditions during a six-month period. Of the 1,200 people hospitalized, nearly 40 percent were readmitted, underscoring addiction treatment is not a “one and done” procedure. Addiction is a chronic illness and hospitals on the front lines cannot be penalized for saving lives. .
• Technology can help. The technology to monitor patients real-time exists and the right approach can be chosen to fit patient need. Certain approaches have been in use for decades, while others are newer: both are proven. Physiological monitoring (e.g., oxygenation, end tidal CO2, etc.) of patients routinely occurs and is a requirement during surgery. The technology that enables patient monitoring only needs to be applied to patients not in the surgical floor. In more recent years, for example, contact-free monitoring of heart and respiratory rates have been implemented in non-acute care environments.
• Success requires training as an investment. The use and implementation of new technology requires planning and a willingness to commit to house staff training. We only need the willingness to do it — a patient’s life, your life or the life of a friend or family member may depend on it. New technologies make it easier to use existing staff effectively and reduce false alarms.

Undeniably, our health system is overburdened. Clinical staff face shortages and burnout; new technologies entail capital as well as training costs; and changing habits or protocols is a massive undertaking. But to prevent unnecessary deaths due to opioid overdoses, we must change our approach to patient monitoring in the acute clinical setting. The current approach to this epidemic — policing, incarcerating and policy hand-wringing — has demonstrated some benefits, but will it be enough to help overcome this disease?

Enabling our hospital system to treat opioid overdoses requires a medical mindset. We should equip our frontline staff with the best medical guidelines, technologies and Federal and state policy support possible. Technology and training to overcome the opioid epidemic is a demonstrated path to success. It’s time to become far more innovative and take action.