Scenario
Educational technology can help to make an organization’s learning strategy more successful. But especially in health care, where treatment and care evolve all the time to respond to new research and changing population issues, no technology can be static for long. At St. Anthony Medical Center, an evolving problem — the national opioid crisis — is forcing leadership to reconsider how some educational technology is being used.
In this activity, you’ll see how changes in conditions, practices, and needs leads to process for charting a response: a needs assessment.
Changing Practices
Kristen Delaney is the credentialing and education specialist at St. Anthony Medical Center (SAMC), a large urban hospital located in Minneapolis, Minnesota. Today, she gets a directive from Elaine Charland, the vice president of medical services at SAMC.
The Email:
From: Elaine Charland
To: Kristen Delaney
Kristen,
I need you to look into something for me. Word is coming down from the higher-ups that there’s an unflattering article coming out about one of Vila Health’s hospitals and their response to the opioid crisis. SAMC has been evolving on this, but I’ve also heard some complaints internally that our response isn’t as good as it could be.
Some of the other department heads are also being asked about other aspects of this, but I need to know whether our learning and development is supporting a better response to the crisis.
There’s a list of people I’d like you to talk to about this. Check with the ER, especially Dr. Connolly; someone, preferably a doc, from the orthopedics division, and Dr. Zuckerman, the psychiatrist at the behavioral health unit. You may want to talk to other people too, but make sure you get those three. Then let me know what you find. Thanks.
– Elaine
INTERVIEWS
Kristen schedules time with each of the people Elaine Charland mandated. She also discovers that she needs to talk to someone in case management to capture what’s happening after hospital treatment is over with.
Dr. Connolly is an ER physician who has worked at SAMC for nearly 10 years.
Kristen Delaney: Dr. Connolly, what’s the state of SAMC’s response to the opioid crisis?
Dr. Connolly: It’s not good. We’ve done the right things publicly, but we need to coordinate our response better across the hospital. I’m in ER, so I see the acute issues — the overdoses, the withdrawal, those sorts of things. What drives me nuts is that I’m seeing a lot of patients multiple times, or at least they come multiple times. We should be administering more doses of buprenorphine to give patients some temporary relief of their withdrawal symptoms and cravings. But while I’m doing that regularly, some of the other docs aren’t — and the clinical decision support system isn’t prompting it! That’s insane. It’s like the CDS is stuck in 2015. We’ve got to get more updated CDS content, so that everyone is following better practices.
Kristen Delaney: What do we need to do better?
Dr. Connolly: Well, it’s not just the ER. We’re the end of the line, or at least the middle. The beginning is when these drugs get prescribed in the first place. Have doctors across the hospital gotten training in best practices for opioid prescription? I’m going to guess no. But the point is, they need it. We don’t need to just respond better to folks who come to the ER with opioid dependence. We’ve got to stop helping them get dependent in the first place!
Dr. Cartwright is an orthopedic physician who has been vocal about changing prescription practices for opioid medications.
Kristen Delaney: Dr. Cartwright, what’s the state of SAMC’s response to the opioid crisis?
Dr. Cartwright: It’s muddled. I don’t know how many doctors there are at this hospital, but you know that they’re scattered across the specialty units, the ER, Med/Surg, and everywhere else. In the orthopedics department, I’ve made sure that every doc has a copy of the latest prescribing guidelines for opioids. But what are they doing in the surgical departments, like Med/Surg or the bariatric unit? Every doctor that could be prescribing meds for post-surgical pain needs to hear about the latest research, but who knows whether any of them are? Do they know about fast-acting versus extended-release formulas? Do they know the risk factors they should be taking into account for each? Is anyone keeping track of this? Is there any training available about it?
Kristen Delaney: What do we need to do better?
Dr. Cartwright: If I were in charge, I’d make sure that learning content about prescribing guidelines got pushed proactively to every doctor with a prescription pad in this hospital. And I’d track how long it’s been since each doc attended training about those guidelines. This is a potential legal issue, when you think about it. Does the hospital know what its doctors are prescribing? Clinics have gone down for being pill mills, but there could be a real liability if someone overdoses and it turns out that docs at this hospital are still giving pills away like candy.
And one more thing. Sigrid Kohl in the Alternative Medicine unit has been trying to promote content she’s developed about pain management with non-opioid options. But I never see any of that in the content that gets pushed to us, nor do I hear other doctors talking about it. Do the training and education folks even know about this? Shouldn’t they, if they don’t?
Dr. Zuckerman has been a psychiatrist with SAMC’s behavioral health unit for 12 years.
Kristen Delaney: Dr. Zuckerman, what’s the state of SAMC’s response to the opioid crisis?
Dr. Zuckerman: I’m encouraged but not enough. For one thing, I hate it when we treat someone for opioid addiction and the original prescription came from a doctor at this hospital. But I really hate it when it’s someone with visiting privileges! I know that doctors here are occasionally required or encouraged to get continuing education. But does the same thing happen with visiting doctors? Is anyone tracking what education they have or prompting them with updated content?
Kristen Delaney: What do we need to do better?
Dr. Zuckerman: Well, I hope we are tracking those kinds of things. But I’m sometimes appalled by what the CDS says about treatment. There have been times when I read one thing in the CDS and almost the opposite in learning content that the LMS pushed my way! They need to synch with each other and both of them need to be more up to date.
Vicki Vasquez is the director of case management at SAMC for five years. She has argued for better coordination of referrals, follow-up calls, and other post-visit interventions.
Kristen Delaney: Vicki, what’s the state of SAMC’s response to the opioid crisis?
Vicki Vasquez: Well, I don’t know about treatment of withdrawal or overdoses. But we have got to include my case managers in any training about addiction support groups! Some of the doctors keep referring patients to NA only, and that’s not good practice. There’s Smart Recovery, there are methadone clinics, there are addiction specialists…if doctors prescribe NA only, I want my case managers to be educated in other options, in case patients say that they don’t want to do a twelve-step program.
Kristen Delaney: What do we need to do better?
Vicki Vasquez: I’d love it if we had our own wiki that our case managers could add to and maintain. Over time, they learn which patients come through again and say that a particular program is no good — or really helpful — and we should have a way to store that acquired knowledge even if case managers come and go.