Hudson Hospital & Clinic, 2024 Quality
The Reality Behind Mortality of Our Hospital Inpatients
At Hudson Hospital & Clinic, the care team's experience within a small critical access hospital revealed a concerning discrepancy: real mortality rates were being underreported. Consequently, accurate targets for prognostication and quality improvement initiatives became unreliable. Upon assessing a sample of general medical inpatients throughout the calendar year 2022, significant findings emerged. Notably, 28% of deaths were not documented in the electronic health record. Furthermore, a nine-month mortality rate was found to be correlated with readmission rates, length of stay, and the patient's disposition prior to death. To address this discrepancy, the team delved into the root causes and developed their own trigger thresholds. These thresholds were designed to prompt meaningful discussions regarding goals of care and thoughtful planning for patient dispositions.
Strategies to Reduce High-Dose Opioid Prescriptions at Discharge for Cesarean Section Patients
Addressing the opioid epidemic is paramount given its profound impact on individuals, families, and communities. Hudson Hospital and Clinic recognized this urgency and prioritized interventions to combat the crisis, aiming to reduce opioids dispensed for home use on discharge prescriptions, including for cesarean section patients, with Morphine Milligram Equivalent (MME) as the unit of measure.
A multidisciplinary team of doctors, pharmacists, and nurses assembled to revise pain control sections of order sets and staff education materials. This team collaborated to review prescribing practices, implement evidence-based changes, adjust order sets, and create educational materials promoting safer prescribing.
It became evident that effective pain control post-cesarean section necessitated a multifaceted approach, moving beyond sole reliance on opioids. Darla Klementz Pharm D, RPh, Director of Pharmacy emphasized this shift, stating, "We needed to depart from the idea that opioids alone provide incisional pain relief." Implementing a regimen of scheduled acetaminophen and NSAIDs alongside opioids as needed proved effective in pain management. Additionally, non-pharmacologic methods such as aromatherapy patches, massage, warm packs, ice packs, music therapy, and early ambulation were encouraged to complement pharmacological interventions.
When opioids are necessary to complement scheduled acetaminophen and NSAIDs, the approach begins with administering the lowest effective dose. Whitney Peterson, MSN, RN, Director of Women’s Center Services, highlights the misconception that higher opioid doses are necessary to manage pain preemptively. Instead, the emphasis is on initiating treatment with the lowest effective dose to prevent overmedication and enhance safety.
Discharge prescriptions are individualized by physicians to ensure adequate pain control during home recovery, considering the patient's unique needs and factoring in opioid use in the last 24 hours before discharge. This tailored approach promotes safer postpartum care and aligns with Hudson Hospital and Clinic's commitment to addressing the opioid crisis and fostering safer prescribing practices. These proactive measures contribute to improved patient outcomes and the overall well-being of the community.
A multidisciplinary team of doctors, pharmacists, and nurses assembled to revise pain control sections of order sets and staff education materials. This team collaborated to review prescribing practices, implement evidence-based changes, adjust order sets, and create educational materials promoting safer prescribing.
It became evident that effective pain control post-cesarean section necessitated a multifaceted approach, moving beyond sole reliance on opioids. Darla Klementz Pharm D, RPh, Director of Pharmacy emphasized this shift, stating, "We needed to depart from the idea that opioids alone provide incisional pain relief." Implementing a regimen of scheduled acetaminophen and NSAIDs alongside opioids as needed proved effective in pain management. Additionally, non-pharmacologic methods such as aromatherapy patches, massage, warm packs, ice packs, music therapy, and early ambulation were encouraged to complement pharmacological interventions.
When opioids are necessary to complement scheduled acetaminophen and NSAIDs, the approach begins with administering the lowest effective dose. Whitney Peterson, MSN, RN, Director of Women’s Center Services, highlights the misconception that higher opioid doses are necessary to manage pain preemptively. Instead, the emphasis is on initiating treatment with the lowest effective dose to prevent overmedication and enhance safety.
Discharge prescriptions are individualized by physicians to ensure adequate pain control during home recovery, considering the patient's unique needs and factoring in opioid use in the last 24 hours before discharge. This tailored approach promotes safer postpartum care and aligns with Hudson Hospital and Clinic's commitment to addressing the opioid crisis and fostering safer prescribing practices. These proactive measures contribute to improved patient outcomes and the overall well-being of the community.
