Ruby Memorial Team Looks to Decrease Opioid Use With New Pain Management Plan

A multidisciplinary team of providers from WVU Medicine J.W. Ruby Memorial Hospital recently created a care plan for pain management that focuses on decreasing the use of opioids when possible.

Called ED ALTO (Emergency Department Alternatives to Opioids), the project was created by emergency medicine physicians Peter Griffin, MD; Owen Lander, MD; Tom Marshall, MD; Brian Dilcher, MD; Chris Goode, MD, FACEP; and Hannah Trickett, PharmD, BCPS, lead clinical pharmacy specialist, Enterprise Medication Use. It was adapted from the Colorado Opioid Safety Collaborative, which showed decreased opioid usage by 36 percent in participating departments.

The treatment goals of the ED ALTO project include using non-opioid approaches as first-line therapy, reserving opioids as second-line treatment or as rescue medications, while also discussing realistic pain management goals with patients, along with the addiction potential and side effects of opioids. Using this plan, emergency medicine providers across WVU Medicine facilities can help to lower opioid use.

ED ALTO has identified five pathways to target multiple pain receptors, making use of non-opioid medications and trigger point injections to tailor a patient’s pain management needs and substantially decrease opioid use. The pathways are not meant to replace clinical judgement, but rather inform and augment it, with an aim of decreasing morbidity and mortality associated with opioid use and misuse. The five pathways address a variety of clinical conditions, such as headache, musculoskeletal/back pain, chronic abdominal pain, renal colic, and extremity fracture/joint dislocation. Order panels have been built in Epic and are now available by searching in “Manage Orders” or the “ED Quicklist” to guide providers in the use of these alternative medications.

For questions or comments, please reach out to Drs. Griffin, Lander, Marshall, Dilcher, Goode, or Trickett.