Rewriting the script: Experts aim to improve pain management and reduce opioid-related harm

December 13, 2018  //  FOUND IN: Our Employees,

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When you have a complicated problem to solve, having diverse ideas and people in the room often produces the best results. With that in mind, Michigan Medicine team members have begun taking a comprehensive approach to solving the opioid epidemic, as specialists both near and far seek ways to battle the crisis.

“So many of our team members are doing great work, but few of them ever get together or even know of one another,” said Paul Hilliard, M.D., medical director of institutional opioid and pain management strategy. “We wanted to put as many of those people in one room as possible, to amplify the power of their work.”

Last month, a team led by Hilliard, Eric Scott, Ph.D., pediatric clinical psychologist, and Katie Barwig, M.S., B.S.N., R.N., nursing staff specialist, hosted Rewrite the Script, a two-day event involving around 200 members of the organization, ranging from doctors and nurses to social workers and physical therapists. Also represented were administrators, researchers, environmental services and patient transporters, more than 20 patients and their caregivers, and community partners and colleagues from MidMichigan and Metro Health.

All the participants were there to brainstorm solutions to an important topic: how to more effectively help patients manage pain and reduce harm from opioid use.

Identifying the problem

About 100 million Americans suffer from chronic pain every day, more than diabetes, cancer and cardiovascular diseases combined, according to the National Institutes of Health.

“It’s pretty clear that this country has far more than just an opioid problem,” Hilliard said. “It has a pain management problem. And what we don’t have right now is a comprehensive way of looking at pain and helping people manage their pain.”

As a result, there is a growing dependence on opioid drugs, which can lead to life-long problems with substance use disorder. It’s an issue that hits close to home — both in the state and region, and within the four walls of Michigan Medicine.

“Heath care providers are the ones writing prescriptions and handing patients medications that are often extremely powerful and addictive,” Hilliard said. “As a major academic medical center that sees thousands of patients battling pain, we need to recognize that we can have a major impact on improving lives and turning this epidemic around.”

‘A microcosm of the health system’

At Rewrite the Script, faculty and staff spent the better part of two days hearing directly from patients and family members — as well as one another.

“We wanted every table to be a microcosm of the health system,” said Fiona Linn, strategic advisor to the chief medical officer and event planner. “We made sure people were sitting with others who they don’t normally interact with so they could hear different perspectives and see the power of working together.”

Patients, families, faculty and staff discussed ways to manage acute and chronic pain, reduce opioid related harm, treat pain in pediatric patients, expand behavioral health interventions, identify ways to better support the care team and share existing resources. There were also breakout sessions to provide more depth and detail on specific solutions.

Eventually, all of the participants came back together to share their findings and recommendations with each other — and with additional Michigan Medicine leaders, who came specifically to hear the report-out.

Next steps

Among the calls to action were the implementation of customized patient-centered pain care plans collaboratively developed with the care team within their electronic health record — allowing portability — and the enhancement of non-pharmacological treatments for pain.

“Patients are struggling right now,” said Jesus Cepero, Ph.D., chief nursing officer and co-executive sponsor of the event. “We have to think differently as a system, and leverage partnerships and broader resources to help people now.”

The participants also recommended creation of a pain education campaign for all employees who interact with patients.

“Right now, not all of our employees are adequately equipped to talk to someone in pain,” said Jeff Desmond, M.D., chief medical officer and another executive sponsor of the event. “This education campaign will be designed to help faculty and staff understand how to better help patients deal with the effects of pain and substance use disorder, and inform them about available non pharmacological therapies.”

Longer term, the organization will look at developing new models of care that include a comprehensive opioid and pain management clinic and recovery center, while clinical support will be streamlined to facilitate more appropriate real-time decision-making around pain and substance use disorder management.

“These are just a few ways we are starting to combat this problem,” Hilliard said. “And it will take a lot of work from everyone in the organization. That’s the only way we can overcome one of the toughest public health challenges we’ve faced at Michigan Medicine.”

Stay tuned to Headlines as more information regarding these action plans are rolled out.