Kentucky Opioid Response Efforts (KORE) - Opioid Stewardship

The impact of the opioid epidemic is well understood and is tremendous by any measure, including lives lost and dollars spent. This epidemic has hit Kentucky harder than many states, with a dramatic impact in rural Appalachian counties. In 2016, UK HealthCare developed a multidisciplinary opioid stewardship initiative to improve prescription protocols as a way to prevent the emergence of opioid use disorders in our patient population and beyond. This initiative has now blossomed to a program, with robust data analysis capacity and dedicated leadership personnel. UK HealthCare has previously proposed partnering with a number of health systems confronting the opioid crisis in their unique communities throughout the State. The health systems included St. Claire Regional Medical Center in Eastern Kentucky, St. Elizabeth HealthCare in Northern Kentucky, Norton HealthCare in Louisville, and Owensboro Health in Western Kentucky. In 2017, a portion of the $650,000 UKRF KORE contract was dedicated to UK HealthCare to establish a connection with and program within St. Claire Regional Medical Center; this has created a collaborative between the campuses, with St. Claire now boasting a multi-disciplinary opioid stewardship task force of its own as well as a plan for data collection and analysis plus education and naloxone dispensation. UK HealthCare now aims to extend this initiative to St. Elizabeth HealthCare in Covington. To begin this partnership, UKHC proposes assisting St. Elizabeth in an opioid stewardship needs-assessment for their hospital. Not only does this include surveying practitioners on current prescription practices, but it also includes an in-depth analysis of available resources to change current protocols and identification of healthcare leaders interested in launching an opioid stewardship effort. As part of this needs-assessment, UKHC will also develop and present educational materials to key stakeholders at the medical center. Interacting with front-line personnel is essential, as it will reveal the true nature of the opioid crisis at the clinical level in Covington, provide feedback to inform needed protocols moving forward, and engender provider buy-in for safe opioid prescribing practices throughout the enterprise. Additionally, compliance with revisions to existing regulations in 201 KAR 9:260, Professional Standards for Prescribing and Dispensing Controlled Substances, namely the restrictions on prescribing for acute pain as modified in House Bill 333, is not currently well elucidated. Therefore, establishing an internal monitoring process regarding prescribing patterns is of utmost importance. To implement the prevention and harm reduction programs associated with this partnership, opioid stewardship leaders from UKHC will continue collaborate with St. Elizabeth to establish tangible, achievable metrics for routinely measuring success. Metrics may include the amount opioids prescribed at discharge, inpatient utilization of opioids, and compliance rates with prescribing guidelines.