MHA Guidelines for ED Opioid Management

MHA, at the direction of its Board of Trustees, formed a Substance Abuse Prevention and Treatment Task Force (SAPTTF or task force) with the goal of developing provider-focused strategies and best practices to address the increase in misuse of opioid pain medication across the Commonwealth.

The MHA guidelines address opioid prescribing practices within hospital Emergency Departments (ED). The task force's hospital workgroup - chaired by Ali Raja, MD, vice chair, Department of Emergency Medicine, Massachusetts General Hospital - seeks to establish a baseline ED operational practice that will:
 

• standardize opioid prescribing practices,
• provide guidance on screening patients seeking opioid prescriptions,
• offer information on appropriate pain management and treatment, and
• help identify resources for patients needing substance use treatment.

The goal is to better enable ED providers to take an active role in limiting inappropriate access to opioid pain medications.  These guidelines have been endorsed and approved by the MHA Board of Trustees, which also directed all hospitals to consider adopting it in an appropriate time frame.

In developing these guidelines, the task force aimed to ensure that hospital emergency departments are not a contributing factor to the increase in opioid misuse throughout the Commonwealth.  In particular, we have worked with the Massachusetts College of Emergency Physicians (MACEP), which has formally endorsed the guidelines.  Our next steps will be to work with the ED clinicians and others to adopt these recommendations in an appropriate manner and time frame.

MHA Guidelines ED Opioid Management
 

• This document provides an overview of the goals and purpose of the guidelines as well as detailed information on the parameters of each recommendation.
• It is important to reiterate that the goal is to set a standard that all providers should follow.  However, due to the type of care and treatment provided in the ED, the guidelines are not intended to interfere with or supersede the professional medical judgment of the treating clinician to determine the right course of treatment (including prescribing practices) based on each patient's medical condition.

Patient Information Sheet
 

• This is a two-page document; the first page contains instructions for the provider only and the second page is the handout for the patient.  The patient information sheet was developed to assist providers with educating patients about the recommendations and the reasons behind its creation.  Hospitals can customize this document or can add the hospital's logo and contact information to the sheet and use as if drafted.
• It is important that hospitals consider the following guidance developed by outside counsel to ensure that the guidelines are not seen as preventing access to medically necessary care:

  -   The guidelines and the patient information sheet cannot be posted in a hospital patient waiting room, triage area, or patient treatment room;

  -   The patient information document is only provided to patients after an appropriate medical screening exam from a healthcare provider in the ED; it may be provided during the discussion involving appropriate treatment for stabilization; and

  -   At no time shall any of these documents be used to coerce or discourage patients, who present to the ED with painful medical conditions, to leave the ED prior to receiving an appropriate medical screening exam and stabilization.