The opioid epidemic is a critical public health issue that not only affects health but also social and economic welfare, costing the country over $78 billion per year. Last year, LMH Health’s emergency department and inpatient pharmacy began discussing how to best serve patients while prescribing the smallest amount of opioid medications possible — a discussion that led to LMH’s Alternative to Opioids Project, or ALTO.

 ALTO is an emergency department project that aims to reduce opioid use by managing certain types of pain with medications other than opioids. This project improved the tracking and trending of opioids administered and prescribed in the ED.

Kyle Eichelberger, a pharmacist with the inpatient pharmacy, said the project aims to coordinate LMH Health’s efforts on responsible pain management and opioid use.

“We want to keep our patients safe,” Eichelberger said. “We found that with ALTO we reduced opioid prescriptions in the ED around 26% for February and 15% for March compared to the prior year.”

The project has several specific goals, Eichelberger said:

• Providing appropriate, timely and safe pain management for all patients.

• Maximizing the use of therapeutic options other than opioids to help reduce risk of addiction, overdose and adverse effects.

• Compliance with regulatory requirements.

• Promoting education on pain management, safe prescription and administration of opioids and patient monitoring.

• Identifying and implementing process improvement activities related to opioid stewardship and pain management.

• Improving patients’ experiences with opioid utilization and pain management. 

Hollie Porras, a 12-month pharmacy resident at LMH Health, said she and Eichelberger, along with numerous other staff members, conducted a study analyzing opioid use in the emergency department that looked at the effect of the ALTO approach to pain management.

“We created and provided educational tools regarding the use and effectiveness of ALTO for the ED providers, pharmacists and nurses,” Porras said. “We also created a flyer to put in each exam room to inform patients of our shift in pain management practices.”

Porras said the study looked at changes in opioids administered in the ED before and after ALTO began. It also looked at the rate at which opioids were prescribed to patients who were leaving the ED, as well as how the patients rated their experiences.

When the results were analyzed, they revealed that the number of opioids administered and the number of opioid prescriptions provided to patients were both significantly lower than in 2019.

“Our study concluded that the implementation of an ALTO pain management protocol in our ED resulted in significant reductions of opioid use without negatively affecting patient experience,” Porras said. “Overall, the ALTO approach allows patients access to effective pain management without exposing them to negative side effects, such as addiction, that can come with opioid medications.”

Jana Wallen, outcomes coordinator at LMH Health, said the project was a labor of love, and that it was successful because of help from many departments within LMH Health.

“This project also included the help of the quality, IT and data analytics departments to get everything built properly,” Wallen said. “We are also excited to announce an event we are hosting with the Lawrence Public Library on Sept. 10 that will focus on the community and their questions about topics such as opioid use, hospital initiatives and safety measures.”

Eichelberger said that without the help of LMH Health’s various departments and community partners, the program and the steps taken so far to reduce opioid use would not be the same.

“Because of our partnerships with (Lawrence-Douglas County Public Health,) DCCCA and Heartland Community Health Center, we have had help breaking down overdose data, getting opioid disposal bags and getting a MedSafe opioid dropbox for patients to safely and securely dispose of the unused prescription opioid medication,” he said.

The implementation of the ALTO program was a success, but LMH Health isn’t stopping there. Eichelberger said the team intends to keep looking for other ways to fight the opioid epidemic.

“Our next steps are to implement the Opioid Dashboard Tool, which offers ED providers a snapshot of their opioid prescribing patterns,” he said. “Additionally, the results of this study indicate that an ALTO-first protocol in other areas of the health system may be worth investigating.”

Panel discussion

LMH Health is planning a virtual panel discussion on opioids next month in partnership with the Lawrence Public Library. The discussion, set for Sept. 10, will focus on the impact of opioid use disorders, risk factors, safe pain management and local community resources in order to open up conversations regarding the opioid crisis across our community and country. 

Panelists at the event will include Dr. Marc Scarbrough; Dr. Patrick Harper; LMH pharmacist Kyle Eichelberger; and Kevin Joles of Lawrence-Douglas County Fire Medical.

For more information, visit the LMH Health website at lmh.org and LMH’s social media pages.

— Jessica Brewer is the social media and digital communications specialist at LMH Health, which is a major sponsor of the Lawrence Journal-World’s health section.