Medication Safety
atom Alliance Improves Nursing Home Quality Through Opioid Safety Training

Almost 460,000 Medicare Part D beneficiaries received high amounts of opioids in 2017, and about 71,000 were at serious risk of opioid misuse or overdose, according to a report by the U.S. Department of Health & Human Services’ Office of the Inspector General.

To protect the health and safety of older Americans, atom Alliance set out to find new ways to manage pain and reduce the number of Medicare beneficiaries using that class of drugs.

As the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Alabama, Indiana, Kentucky, Mississippi and Tennessee, atom Alliance decided to take the innovative route of tailoring a pain management program that had originated in hospitals and making it work for nursing homes.

The initiative’s results show how successful the training was for nursing homes. Non-opioid pain treatments nearly tripled on average at each nursing home, rising from 12 to 42, and there was a 7.5 percent relative reduction in opioid use.

The program involved monthly virtual collaborative meetings where atom Alliance staff pharmacists outlined Centers for Disease Control and Prevention guidelines for prescribing opioids, as well as explained the use of “comfort menus,” which offer non-pharmacological options to manage pain. Twenty nursing homes participated in the trainings between January and May 2018, and the overall goal was to reduce the number of residents with opioid orders in participating nursing homes by 10 percent and to increase the number of non-opioid pain treatments per participating facility by 25 percent.

atom Alliance also wanted to help participants improve their Nursing Home Quality Composite Measure Score, which uses 13 metrics to show quality improvement in long-term care settings. Lower composite measure scores are considered better as they represent systems improvement in the nursing home, such as fewer resident falls.

The initiative’s results show how successful the training was for nursing homes. Non-opioid pain treatments nearly tripled on average at each nursing home, rising from 12 to 42, and there was a 7.5 percent relative reduction in opioid use.

The Nursing Home Quality Composite Measure Score decreased from 7.89 to 6.63 on average among participating nursing homes. Of the 13 metrics that comprise the composite score, participants improved in four categories related to opioids, including weight loss, pressure ulcers, falls with a major injury, and pain level.

Beyond the quantitative success of atom Alliance’s initiative, nursing home providers have said that the training made it a lot easier to find creative ways to treat pain.

“We have a clearer understanding and direct pathway on how to use non-pharmacological approaches to pain,” one nursing home participant told atom Alliance.

For 2019, atom Alliance plans to continue the training and widely promote the comfort menu approach to pain management, which has been well-received by nursing homes that have adopted it.