QHC cuts opioid prescribing by 36 per cent

Dr. Edward Woods stands in the Belleville General Hospital surgical recovery room Monday. Quinte Health Care teams have since April reduced opioid prescriptions by 36 per cent. Luke Hendry/The Intelligencer

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Doctors and staff of Quinte Health Care’s surgical department have reduced the number of opioid prescriptions by more than one-third and are trying to reduce it even further.

Four surgical divisions – general surgery, orthopedics, gynecology and urology – have since April been changing their approach to prescribing the powerful painkilling drugs. Opioids or narcotics include morphine, codeine, oxycodone, hydromorphone, tramadol and fentanyl.

It’s part of Cut the Count, an opioid-reduction campaign of Health Quality Ontario, a provincial advisory agency.

The campaign challenges 47 hospitals to cut prescriptions by 30 per cent between April 2019 and March 2020.

“We have reduced by 36 per cent,” said QHC’s surgical program director, Kristina Cruess, a registered nurse. She noted doctors surpassed the provincial goal without knowing the target of 30 per cent.

In an interview Monday at Belleville General Hospital, she reported an “incredible” reduction in the number of pills.

She said about 207,360 pills per year had been prescribed at QHC hospitals. That’s since dropped to 125,670.

Belleville had the sixth-highest adjusted rate of hospitalization due to opioid poisoning between 2013 and 2018, researchers with the Canadian Institute for Health Information reported in December.

And in 2017, an average of 11 people per day died of an opioid overdose. Canada is second only to the United States in opioid consumption.

“It’s important to realize that we have a part in battling the opioid crisis,” Dr. Edward Woods, a QHC urologist, said Monday between surgeries at BGH.

He said teams in anesthesia and surgery have studied not only the number of opioids prescribed but also the nature of them.

Cruess noted it was a targeted effort, focusing on selected surgeries: removal of the prostate, uterus and gallbladder and total replacement of hips and knees.

“We can use alternative ways of treating pain: everything from using local anesthetic agents to non-steroidal anti-inflammatories, even simple Tylenol,” said Woods.

“Integral in this process has been educating the surgical staff – anesthesia, nursing, and the surgeons. The administration has brought in special rounds and has made special attempts to try to educate us and bring us up to date.”

“We’ve been able to substantially reduce the number of opioid prescriptions and the quantity per prescription,” he said.

“And it really hasn’t affected patient care. In fact, it has improved it, because we’re avoiding some of the side effects of opioid painkillers.

“We’re not only concerned about our patients – we don’t want our patients to be in pain – but we don’t want a situation where there’s half-filled bottles of painkillers at patients’ homes that can be accessed by unauthorized people,” Woods said.

The surgical divisions met to agree upon a standardized prescription to be used after surgery. It includes more acetaminophen and ibuprofen, both lower-strength painkillers than opioids. It also includes smaller prescriptions of opioids to be filled only if needed.

“Our goal was for 75 per cent of patients who receive that surgery … to receive the standard script,” she said. In August, QHC reached 80 per cent.

She said some surgical divisions reported less reduction because they had already made some changes prior to the campaign.

Prescriptions are also split. The patient gets only a small number of pills from the pharmacy at a time and must return to get more.

Anesthetists, meanwhile, have altered – but not stopped – their use of narcotics given during surgery to decrease patients’ feel after their operations.

Staff have increased public education, providing leaflets pre-surgery about pain control and including more information in the discharge process.

“We’re really drilling into patients to have pain expectations and how to manage it,” said Cruess.

The goal is to reduce pain to tolerable levels so patients can perform their daily activities. But there is no zero-pain target.

Cruess said patients are advised to begin by trying to manage pain with ibuprofen or acetaminophen, then proceed to opioids only if needed.

Patients are encouraged to return unused opioids to the pharmacy to reduce the chance those drugs will end up in the wrong hands, possibly even on the street.

“I think it’s been – up to this point – successful,” said Woods.

“There are some people who unfortunately are already on chronic pain medicines and they’re difficult. But we’re trying to help.

“There are some resources available to try to get people from of the really addictive medicines,” he said, adding in some cases the goal is to help patients receive rehabilitation.

Cruess said staff continue to monitor the campaign, including trying to track whether patients return to emergency departments due to pain. Doctors are also following up with patients.

“A lot of the patients are using maybe half their narcotics,” said Cruess.

“We’re trying to figure out how to leverage this and spread it to other patient populations.”

She said there isn’t yet a longer-term strategy but there are hopes for further reductions.

“The magnitude of what they’ve done is actually greater than what we’re measuring,” Cruess said. The prescribing methods are now being applied to other surgeries beyond the target group.

“I’m very, very happy and pleased with this.”

Quinte Health Care surgical program director Kristina Cruess displays a page from the provincial Cut the Count opioid-reduction campaign Monday. Luke Hendry/The Intelligencer/Postmedia Network Luke Hendry/The Intelligencer

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