Opioid Utilization & Misuse Success Story: Real Time Medical Systems

In May 2023, Quality Insights, in collaboration with Real Time Medical Systems (Real Time), initiated a strategic effort to decrease opioid utilization in nursing homes through the formation of a pilot work group. This program provided data-driven technology to track and analyze opioid usage, as well as offered multiple supportive educational trainings and technical assistance.

Quality Insights has partnered with Real Time since October 2022 to offer nursing homes in Pennsylvania and West Virginia access to their data analytics platform. Real Time’s Clinical Dashboard help facilities reduce hospital admissions and improve care coordination efforts by transforming post-acute electronic health record (EHR) data into actionable insights.

Note: The names shown are from the test site and are not real people.

In March 2023, Real Time enhanced its Adverse Drug Event Dashboard monitoring to include opioids. Following that enhancement, Real Time’s Opioid Dashboard was incorporated into Quality Insights’ Nursing Home Opioid Reduction Program, which was developed by Dr. Jean Storm, Quality Insights’ Medical Director.

This educational program consisted of eight sessions aimed at tackling various opioid-related issues, including guidance on the risks of using opioids and benzodiazepines together, the significance of opioid tapering, the implementation of opioid risk assessments, and the ways Real Time can support these efforts. Quality Insights also supplied participating facilities with resources like the Opioid Risk Assessment Tool.

Note: The names shown are from the test site and are not real people.

Real Time’s Clinical Dashboard enabled participants to assess opioid use in their facility and monitor their progress while implementing strategies from the program. Additionally, Real Time assisted facilities in the program by offering town hall educational sessions, monthly training sessions, and individualized support.

Data was collected weekly for two months and then on a monthly basis to track progress. The educational component was designed using the Kirkpatrick Model to ensure effective learning and retention. The findings from this workgroup are below:

• Participating facilities demonstrated an over 40% improvement in average readmission rates, resulting in an ROI of $38,700
• A 0.5 increase in overall star ratings was observed across the six participating facilities
• Instances of survey citations and severity concerning opioid use dropped from five to zero, indicating a significant reduction in opioid-related citations
• Course post-tests were 100% for all participants, with the exception of one question related to describing algorithm recommendations

Post-evaluation examples of confidence include increased knowledge across all instructional areas:

• Nursing Home Opioid Strategy Importance went from 33.3% to 66.7%
• Opioid and Benzodiazepine Use Knowledge increased from 26.7% to 66.7%
• Importance of Screening for Opioid Risk went from 28.6% to 71.4%

In an analysis of all its users from March 2023 to July 2024, Real Time’s data indicates a significant reduction in total patient opioid prescriptions, as well as a decrease in high-risk opioid use through multiple prescriptions and in combination with high-risk diagnoses.

The efforts of Quality Insights and Real Time underscore the effectiveness of targeted educational collaboration, risk assessment, and continuous support in helping nursing facilities to reduce opioid dependence and improve resident care. This initiative equips all staff with the knowledge necessary to understand and implement this important quality improvement effort.

Figure 1: The graph above shows the trends of opioid prescriptions in facilities that utilized Real Time’s technology from March 2023 - July 2024. The blue line shows the total number of facilities in the Quality Insights QIO program that had opioids. The orange line shows the total number of opioid orders per facility month over month.