Neetu Mahendraker
Indiana University Health Medical Center
Title: Opioid Tolerance Leveling: A novel strategy to manage pain safely and effectively in hospitalized non-surgical patients
Biography
Biography: Neetu Mahendraker
Abstract
Hospitalists frequently provide pain management for medical patients, post trauma and post-surgical patients. It is well recognized that there is lack of knowledge in standardizing opioid administration in the inpatient setting.
Opioid tolerance leveling (OTL) is a novel strategy where patients are leveled based on their daily morphine equivalent dosage (MED) intake prior to hospitalization. This is the first pilot known to the best of our knowledge addressing standardization of opioid usage in non-surgical patients
Patients on chronic daily opioids were leveled on admission from naïve to tolerant based on their daily MED intake over 45 days prior to hospitalization. OTL 1 patients had intermittent MED intake, OTL 2 patients had 15-90 mg daily MED intake and OTL 3 patients had greater than 90 mg of daily MED intake. The patients were placed under a respective order set based on the OTL category. Each pre-populated order set had increasing dosages and frequency of intravenous and oral opioid choices calculated to be safely administered to that category of patients. Retrospective data analysis was completed on 48 patients.
Safety of the OTL order set was demonstrated by the lack of naloxone administration in the sample. This pilot showed higher incidence of opioid tolerance as hypothesized in all OTL3 patients but also strikingly in OTL2 patients with psychiatric issues supporting early addiction consultation in these patients. By incorporating this standardized novel order set into their clinical practice hospitalists can now use opioids safely and effectively to manage pain in the hospitalized non-surgical patients.