Against the backdrop of the COVID-19 pandemic, the opioid epidemic continues to rage, fueled in part by the mental health challenges that accompanied COVID-19. The CDC recently reported an average increase in opioid overdose deaths of 30% during 2020 as compared to the previous year.

During this period, the IPRO QIN-QIO has been committed to providing nursing homes with quality improvement expertise including technical assistance and education to support them in their response to both the COVID-19 pandemic and the opioid crisis. Our work has focused on the appropriate use of opioids and efforts to prevent adverse drug events (ADEs) among vulnerable and high-risk patients.

Education and information regarding naloxone use in nursing homes is limited, which represents a serious medication safety gap. In April 2021, IPRO conducted a Nursing Home Naloxone Assessment to gain a better understanding of the use of naloxone in the nursing homes working with us. With 86 responses from each state in IPRO’s QIN region and DC, the survey found that:

  • 20.7% do not have naloxone in their emergency kit or dispensing machine
  • About 50% require naloxone to be individually prescribed for use as needed in the event of opioid overdose emergency
  • 36.5% expressed a desire for naloxone training, protocols, or other opioid related resources
  • One facility identified that their emergency naloxone was expired

Using this this data, in June 2021 the IPRO QIN-QIO developed an educational Nursing Home Naloxone Best Practices webinar to provide guidance on protocols and resources. This webinar featured a nursing home consultant pharmacist who reviewed the American Society of Consultant Pharmacists (ASCP) Opioid Stewardship Toolkit for post-acute care. It also included representatives from nursing homes who shared their best practices and discussed a powerful case study regarding a resident who overdosed during his short-term rehab stay. The facility shared lessons learned from this tragic case. Their immediate response included revisiting the institution’s naloxone policy; ensuring that they maintain a supply of naloxone; educating clinical staff on recognizing signs of overdose and administering naloxone; initiating a standing order for naloxone for all residents admitted on opioids; and flagging the face sheet for residents with a history of substance abuse. In addition, they conducted drills to prepare staff to respond to an overdose emergency.

In order to maximize spread of this valuable content, the original one-hour presentation was edited down to two shorter learning modules. The first focused on the ASCP Opioid Stewardship Toolkit. In just a few weeks, it has already logged additional views on YouTube. The second module, in which nursing homes share their best practices and case studies, has also garnered additional attention on YouTube. Based on our website statistics, it is estimated that this educational resource has reached more than 265 professionals to date. The video series, promoted as “Nursing Home Naloxone Best Practices,” continues to be shared on IPRO’s QIN-QIO channels and is generating additional interest.

We followed up on these presentations with an Opioid & Pain Management Best Practice webinar on September 22. This educational event featured Jonathan Siff, MD, and Joan Papp, MD, of MetroHealth System, discussing electronic health record integration of a naloxone clinical decision support system. Also featured was an overview of medications to treat opioid use disorder in the long-term care setting by Rob Accetta, RPh, BCGP, President of Rivercare RX Consulting. Continuing medical education credits were provided. A recording of that presentation will be available for archived viewing on our website.

IPRO’s multipronged focus on this crisis continues. We recently launched a publicly available Opioid Utilization Dashboard that provides state- and county-level mapping of opioid utilization using Medicare data for four six-month time intervals. The dashboard contains data points such as overall opioid use as well as opioids prescribed in combination with benzodiazepine. In the near future, the dashboard will also include other dangerous drug combinations as well as health equity and disability data. A video tutorial linked to the dashboard provides an instructional roadmap for navigating the site.

While our initial Nursing Home Assessment is complete, we continue to monitor uptake of opioid best practices and to identify facilities that are interested in receiving training and information. Through interventions such as these, we are committed to reducing the harm, including mortality, resulting from opioid use and misuse across the care continuum.

Submitted by Theresa Jacobellis on behalf of IPRO.