Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting

Stephanie P. Van, Ada Lyn Yao, Teresa Tang, Margaret Kott, Amira Noles, Nicholas Dabai, Alexis Coslick, Solomon Rojhani, Lee Ann Sprankle, Erik Hans Hoyer

Research output: Contribution to journalArticle

Abstract

Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (N=788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.

Original languageEnglish (US)
JournalArchives of physical medicine and rehabilitation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Risk Reduction Behavior
Quality Improvement
Opioid Analgesics
Inpatients
Rehabilitation
Naloxone
Confidence Intervals
Prescriptions
Patient Education
Appointments and Schedules
Maintenance
Outcome Assessment (Health Care)
Education

Keywords

  • Naloxone
  • Opioid analgesics
  • Opioid-related disorders
  • Patient education as topic
  • Quality improvement
  • Rehabilitation
  • Risk reduction behavior

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting. / Van, Stephanie P.; Yao, Ada Lyn; Tang, Teresa; Kott, Margaret; Noles, Amira; Dabai, Nicholas; Coslick, Alexis; Rojhani, Solomon; Sprankle, Lee Ann; Hoyer, Erik Hans.

In: Archives of physical medicine and rehabilitation, 01.01.2019.

Research output: Contribution to journalArticle

Van, Stephanie P. ; Yao, Ada Lyn ; Tang, Teresa ; Kott, Margaret ; Noles, Amira ; Dabai, Nicholas ; Coslick, Alexis ; Rojhani, Solomon ; Sprankle, Lee Ann ; Hoyer, Erik Hans. / Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting. In: Archives of physical medicine and rehabilitation. 2019.
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abstract = "Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (N=788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95{\%} confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43{\%}, 95{\%} CI: 25{\%}-63{\%}; early QI period: 10{\%}, 95{\%} CI: 3{\%}-28{\%}; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95{\%} CI: 4-25) times higher than during baseline (late QI period: 29{\%}, 95{\%} CI: 17{\%}-45{\%}; baseline: 4{\%}, 95{\%} CI: 1{\%}-10{\%}; P<.001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.",
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AU - Van, Stephanie P.

AU - Yao, Ada Lyn

AU - Tang, Teresa

AU - Kott, Margaret

AU - Noles, Amira

AU - Dabai, Nicholas

AU - Coslick, Alexis

AU - Rojhani, Solomon

AU - Sprankle, Lee Ann

AU - Hoyer, Erik Hans

PY - 2019/1/1

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N2 - Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (N=788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.

AB - Objective: To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit. Design: Prospective cohort quality improvement project. Setting: Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution. Participants: Patients admitted to ACIR between December 2015-November 2016 (N=788). Interventions: An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project. Main Outcome Measures: (1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge. Results: The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P<.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P<.001). Conclusions: Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.

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KW - Opioid analgesics

KW - Opioid-related disorders

KW - Patient education as topic

KW - Quality improvement

KW - Rehabilitation

KW - Risk reduction behavior

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