Opioid Consenting: A Novel Program to Address Opioid Safety

Abstract

Purpose. The purpose of this program evaluation was to determine the impact of St. Joseph’s opioid consent initiative on naloxone (Narcan) use and opioid prescribing patterns at discharge in accordance with recommendations and strategies set forth by the CDC and ADHS to increase opioid patient safety.Background. Opioids are commonly used in managing moderate to severe pain in the hospital setting (Costello, 2015). In the United States (US), opioids are the most common drug class of prescriptive medication (Stepan et al., 2019). Coincidentally, opioids are classified as a leading cause of death in individuals under 50 years of age in the US with overdose fatalities from opioid use steadily increasing over the last 20 years across the country (National Institute on Drug Abuse [NIDA], 2015; Stepan et al., 2019). In Arizona, more than two people die each day because of opioid overdose (ADHS, 2020). Since 2017, and for each year thereafter, Maricopa County has consistently reported the highest number of verified overdose cases for commonly prescribed opiates (ADHS, 2020). St. Joseph’s hospital developed an opioid consenting program to attempt to address prescription opiate safety in the community by targeting patient’s disembarking the acute setting by offering opioid educational awareness for informed decision making regarding the inclusion of opioids in their care regimen at discharge. Methods. A formative program evaluation using pre and post outcome measurement comparisons to examine the effect of opioid consenting on documented Narcan administrations and discharge opioid prescriptions six months before and after program implementation. Results. Opioid prescriptions from the pre-implementation period (Mean = 1039.18, SD = 1445.09) decreased significantly, Z = 2.7136, p = .00666 compared to the post-implementation period (Mean = 674.73, SD = 1045.09). The difference in Narcan use from the pre-implementation period (Mean = 85, SD = 90.51) and post-implementation period (Mean = 96.5, SD = 105.36) was not significant, Z = 1.41421, p = .1573, alpha = 0.05. Conclusions. The significantly decreased number of opiate prescriptions cannot solely be attributed to initiation of the opioid consent program due to indeterminable effects of multiple unmeasured confounding factors. Further evaluation is warranted.