Massachusetts Health & Hospital Association Substance Use Disorder Prevention and Treatment Task Force
The Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) was developed at the direction of the MHA Board of Trustees to develop provider focused strategies to help address the high incidence of opioid misuse that affects our communities. The SUDPTTF is focused on developing operational practices within hospitals and physician practices that would assist in reducing the number of opioid pain prescriptions and result in a corresponding reduction in the number of opioid overdoses that are occurring in Massachusetts.
Task Force Guidelines
Guidelines for Opioid Management within a Hospital Setting
The SUDPTTF has approved and issued a second set of guidelines outlining several provider and operational recommendations related to prescribing opioid and/or opiate medications within a hospital setting, including hospital owned/affiliated clinics or physician practices. The goal is to develop a general standard for limiting the use of or finding alternatives to prescription opioids. We encourage all hospitals to adopt the recommendations. The guidance includes the following materials:
- Guidelines for Opioid Management by Clinicians and Staff within a Hospital Setting
- Suggested Opioid Prescribing Guidelines Flowchart, - Provides a quick, visually graphic picture of the prescribing process for physicians and providers who prescribe opioids as outlined in detail within the guidelines.
- Physician/Prescriber Reminders When Prescribing Opioids, - Jointly issued by MHA and Massachusetts Medical Society, - Provides a quick checklist of reminders for physicians and prescribers to reference when issuing opioid medication.
Pain Stewardship Program – Jointly released by Beth Israel Deaconess Hospital- Plymouth and Mallinckrodt Pharmaceuticals, provides acute pain management resources and tools to help institutions educate patients and provide improved assessments and non-opiate treatments options for acute pain.
- Provider Core Competencies, - Jointly issued by MHA, MMS, COBTH, and DPH – Hospitals with a residency and/or fellowship program are requested to include these core competencies as part of their trainings to ensure that all future providers are aware of and meeting expected prescribing standards for opioids.
- Naloxone Standing Order Best Practices,- A summary of the state - recommended steps that facilities should follow if they choose to adopt a standing order within their internal pharmacies.
- Template Patient Fact Sheet, - Jointly issued by MHA and Massachusetts Medical Society, - It is recommended that patients are provided this form when a prescription opioid is issued (or a provider may use some or all of this language in your existing fact sheets provided to patients)
- Folha de informações ao paciente (Portuguese patient fact sheet)
- Hoja informativa para el paciente ((Spanish patient fact sheet)
- Template Medication Storage Fact Sheet, - Proposed recommendations for safe and appropriate storage of opioid medications within a patient’s residence that may also be provided to patients when a prescription is issued.
- Available Drug Disposal Options, - Provides an overview of local and statewide appropriate and safe disposal options for opioids. Also provides space for a hospital to include information on disposal options within each facility, if available.
- Hospital Commitment Letter, - Asking all hospitals to complete to demonstrate their commitment to each of the six provider and eight operational recommendations.
- Members who signed the Opioid Management within a Hospital Guidelines commitment letter.
Emergency Department Opioid Management Guidelines
The first guidelines developed by the task force impacts opioid prescribing practices within hospital Emergency Departments (ED). The ED Opioid Management Guidelines establish a baseline ED operational practice that will: standardize opioid prescribing practices, provide guidance on screening patients seeking opioid prescriptions, offer information on appropriate pain management and treatment, and help identify resources for patients needing substance use treatment. The overall goal is to better enable ED providers to take an active role in limiting inappropriate access to opioid pain medications. The materials include the following:
- MHA Guidelines for Emergency Department Opioid Management
- Emergency Department Opioid Management Patient Information Sheet
- Members who have signed the Emergency Department Guidelines Commitment Letter
- The President's Commission on Combating Drug Addiction and the Opioid Crisis
- AHA's Stem the Tide: Addressing the Opioid Epidemic
- Screening Tools Resource Packet
- MHA Annual Emergency Medicine Conference 2015 Slide Deck – All Presentations
- CDC AHA Prescription Opioids, What you need to know, June 2016
The specific action items of the MHA proposed Substance Use Disorder Task Force will be to consider the following:
1. Develop provider specific medical protocols or other clinical practices that will ensure better outcomes of care for substance use disorder patients after receiving care at a healthcare facility by :
a. improving prescribing practices; and
b. changing internal clinical care protocols within the facility (hospital, clinic, medical home, community health center) related to treatment plans and patient education on the use of opiate prescriptions.
2. Coordinate and share hospital specific best practices/strategies for medical protocols and clinical practices among healthcare providers.
3. Organize subgroups to assist with monitoring and advocating for federal and state regulatory actions that would assist with implementing medical protocols or clinical practices
a. Including but not limited to advocating with public and private payers to remove financial incentives through patient satisfaction measures to prescribe greater opiate prescriptions.
4. Identify and link hospitals with existing state resources, grants, and other funding to assist with developing community education, clinical practices, and operational policies;