Identification of barriers and facilitators to the implementation of an opioid-alternative protocol to treat patients with migraine in the emergency department

Abstract

The Centers for Disease Control and Prevention list prescription medication (opioid) overdoses as the leading cause of death because of injury in the United States. This overwhelming statistic has led to what is now being considered an opioid epidemic and a national crisis. Provider opioid-prescribing practices have been recognized as one of the key components contributing to our nation's opioid epidemic. Hospital emergency departments (EDs) have been identified as one possible area for focused intervention. Even though ED providers write a small percentage of the total opioid prescriptions, many opioid-addicted patients have linked their first exposure to opioids with visits to the ED. To prevent a future generation of opioid-addicted individuals, literature reviews have shown education as well as the consistent use of pain management guidelines and protocols could help improve provider opioid-prescribing practices. Protocols for non-opioid pain management have the potential for great impact on the care patients receive in the ED as well as reducing opioid use and misuse in our country. For purposes of this quality improvement project, an opioid-alternative protocol for managing migraine was evaluated for use in a Pacific Northwest Hospital (PNWH) ED. This project utilized a constant comparison technique to evaluate the effectiveness of an educational intervention by evaluating results of surveys provided before and after the educational intervention. The intervention was based on a thorough review of the literature and current evidence-based migraine and opioid prescribing guidelines. The intended outcome of this project was threefold. The student investigator wanted to determine whether education could improve opioid knowledge among providers (MDs, NPs, PAs) and nursing staff at a PNWH ED; reduce perceived barriers toward implementation of opioid alternative protocols in the ED; and facilitate the implementation of an opioid-alternative protocol for migraine in the emergency department, thus improving provider opioid-prescribing practices. Survey comparisons showed how nursing and provider knowledge regarding the opioid epidemic and commonly used opioid-alternatives for managing migraine pain was improved, many perceived barriers toward the implementation of opioid-alternative protocols in the ED were reduced, and support for the implementation of an opioid-alternative protocol to treat patients with migraine in the ED was achieved as a result of this project.