In the last decade, death rates associated with opiod pain medication have increased, with approximately 420,000 emergency department (ED) visits in 2011 related to misuse or abuse of narcotic pain relievers. In 2013, nearly 1.9 million individuals abused or were dependent on prescription opioid medication alone. National guidelines recommend methods for the assessment and treatment of acute and chronic pain in acute care settings, including routinely checking state Prescription Drug Monitoring Programs (PDMPs) for patients on controlled medications, and use of an abuse risk screening tool. An internal review of an urban Emergency Deparment found no standardized opioid prescribing guidelines for acute or chronic pain, and infrequent prescriber access of state PDMPs when prescribing controlled medications such as schedule II drugs. The purpose of this project was to educate ED providers on national guidelines for the prescribing of opioids, treatment of acute and chronic non-cancer back pain, and routine use of PDMPs when prescribing controlled medications. The system change involved educating prescribers on use of the Diagnosis, Intractability, Risk, and Efficacy (DIRE) tool, national guidelines for the assessment and treatment of acute and chronic back pain with routine use of PDMPs in the ED. This change process applied the Iowa Model of Evidence-Based Practice (EBP) and Rogers’ Diffusion of Innovations theory.
