A program developed at McAlester Regional Health Center is getting national attention for its success reducing the use of addictive medication to treat patients.
The MRHC HOMES (Hospital Opioids Maintenance of Efficacy & Safety) program is being shared with hospitals across Oklahoma, and across the country.
The hospital reduced the amount of opioids prescribed by 30.3 percent (Daily Morphine Milligram Equivalents) during the first year of the program, in 2016. The program is also credited with a 15 percent decrease in the time patients spend in the hospital, a 16 percent reduction in patient falls, and a 28 percent drop in Adverse Drug Events (defined as anything from constipation or a rash to death) related to opioid use.
“The program was developed by a team of experts here at MRHC in 2015,” said MRHC CEO David Keith. “It is a vital step in meeting the needs and concerns specific to Southeast Oklahoma, and serves as a catalyst to create a stronger mental health consortium throughout our state.”
Dr. Jason McElyea, Director of Medical Education at MRHC and Program Director for its Family Medicine Residency Program, has presented HOMES (available on the MRHC website at https://www.mrhcok.com/patients/patient-safety ) to the McAlester City Council and McAlester Mayor John Browne’s Drug Forum.
“The hospital has moved away from using any opioids in its emergency department, and is limiting use to surgical and fracture cases only,” McElyea told the community forum in February. “The practice has reduced the number of patients identified as chronic users who came to the emergency room for pain relief only.”
“This has the added bonus of limiting the supply of drugs in our community. It allows us to spend more time on the truly ill, which decreases the amount of time patients are waiting in our ER for treatment,” noted Jason Bray, hospital CIO and member of the hospital Stewardship team that developed the program. Other team members are Robbie Savely, Pharm. D, BCPS; Chief of Staff Christopher Beene, MD; resident Chelsea Berges, DO; hospitalists Timothy Cook, MD, Zane DeLaughter, MD, and Kristin McElyea, DO; Pharmacy Director Larry Auld, and Case Management Supervisor Melissa Peckio.
J. McElyea is presenting the HOMES program this month to the American Academy of Family Physicians as an Innovation Spotlight during a conference in Kansas City for Family Practice physicians from across the nation. In April, the doctor and Savely will travel to Las Vegas to present to Quality health professionals of the Vizient Network, a group of more than 5,000 health organizations nationwide. McElyea said he also was invited to present in Washington, DC, last month on behalf of opioid epidemic awareness but had to decline due to scheduling.
“Our program is a beacon for other hospitals struggling with opioid use in the country,” said CEO Keith.
In Oklahoma, HOMES presentations have been requested by Oklahoma State University’s 26 residency programs at Tulsa, St. John Medical Center’s hospitalist group in Tulsa and Integris Baptist Medical Center’s hospitalist group in Oklahoma City, according to J. McElyea.
At MRHC, program strategies include educating physicians about their level of opioid prescriptions and how their levels compare with those of fellow physicians. The HOMES program also includes continuing medical education sessions about CDC recommendations, and a new element of opioid monitoring by the hospital pharmacy.
J. McElyea said Stewardship Committee member Savely, pharmacist, “has really moved this program forward at our hospital.”
“The pharmacy might see an order for a patient for IV opioids, and the pharmacist will call the doctor and say, ‘Hey, did you consider an oral version of this drug instead?’” Savely explained. “Sometimes it’s just a matter of calling their attention to an alternative that they might not have considered.
“This program shows ways we can reduce the amount of narcotics written in the hospital setting to improve patient safety without impacting patient satisfaction.”