Background: 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 opiod 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 opiod prescribing guidelines for acute or chronic pain, and infrequent prescriber access of state PDMPs when prescribing controlled medications such as schedule II drugs. Framework: The purpose of this project was to educate ED providers on national guidelines for the prescribing of opiods, 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. Methods: For the purpose of this project, the desired outcomes were increased prescriber utilization of state PDMP, resulting in opiod prescriptions for qualifying patients per recommendations from published guidelines and patient DIRE score in chronic pain patients. Measured outcomes included documented PDMP review prior to opiod prescription, documented DIRE score for chronic pain patients, and treatment per guidelines recommendations for acute and chonic pain before and after provider education. Chart review of relevant encounters provided data on changes in prescriber behaviors after the intervention. Findings: A guided chart review identified encounters in which participating providers saw patiens for acute and chronic back pain. A Chi-square analysis was performed on two classes of medications which showed significant changes pre and post intervention. Providers frequently treated according to guideline recommendations for opiod prescriptions, though did not document PDMP review. No patients were seen for chronic back pain, therefore no documentation of the DIRE tool was indicated. Conclusion: Significant changes in prescriptions of non-steroidal anti-inflammatories and muscle relaxers were noted after provider education, though no change was noted in PDMP review. Future studies should focus on expanding provider involvement and greater study duration in order to capture significance. Multiple national agencies have developed EBP recommendation to guide prescribers toward safe and evidence-based prescription of opiods for acute and chronic non-cancer pain. Evidence suggests these methods will reduce abuse, misuse, and overdose-related death.
