{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T15:30:53Z","timestamp":1747063853625},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"15","license":[{"start":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T00:00:00Z","timestamp":1593475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>The design and implementation of alternatives to opioids (ALTO) order sets for the treatment of acute pain in a community health system\u2019s emergency departments are described.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Summary<\/jats:title>\n                  <jats:p>Healthcare institutions nationwide have incorporated policies and procedures to assist prescribers in the safe and effective management of pain. These adopted approaches may be targeted at mitigating opioid prescribing as well as promoting the optimization of nonopioid analgesics. Institutions that enact innovations and track outcomes may be eligible for reimbursement through the Centers for Medicare and Medicaid Services\u2019 Merit-based Incentive Payment System. Emergency departments may monitor implementation progress and outcomes through participation in the American College of Emergency Physician\u2019s Emergency Quality Network. Clinical pharmacists were tasked with assisting an institution\u2019s emergency departments to create and implement two order sets containing ALTO analgesics and supportive medications for atraumatic headache and general acute pain management. Key steps of order set implementation included collaborative development with emergency department providers, implementation with information services, and the development of provider-focused education by project pharmacists. The implementation of ALTO order sets has set the foundation for expansion of pain control protocols and algorithms within our institution. Furthermore, the approach detailed in this article can be adapted and implemented by other healthcare systems to help reduce opioid prescribing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The implementation of ALTO order sets within an electronic health record can encourage decreased prescribing of opioids for the treatment of acute pain, promote and optimize dosing of nonopioid analgesics, and may augment reimbursement for services in the emergency department.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxaa166","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T06:33:59Z","timestamp":1593498839000},"page":"1258-1264","source":"Crossref","is-referenced-by-count":3,"title":["Implementation of order sets for opioid alternatives in community hospital emergency departments"],"prefix":"10.1093","volume":"77","author":[{"given":"Jared","family":"Netley","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Parkview Health, Fort Wayne, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Parkview Health, Fort Wayne, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Meeks","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Parkview Health, Fort Wayne, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,6,30]]},"reference":[{"key":"2020072304565398300_CIT0001","author":"National Institute of Drug Abuse"},{"key":"2020072304565398300_CIT0002","author":"Whitehouse.gov"},{"issue":"7","key":"2020072304565398300_CIT0003","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1001\/jamapsychiatry.2014.366","article-title":"The changing face of heroin use in the United States: a retrospective analysis of the past 50 years","volume":"71","author":"Cicero","year":"2014","journal-title":"JAMA Psychiatry."},{"key":"2020072304565398300_CIT0004","author":"American College of Emergency Physicians"},{"key":"2020072304565398300_CIT0005","author":"American College of Emergency Physicians"},{"issue":"3","key":"2020072304565398300_CIT0006","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.annemergmed.2017.06.043","article-title":"Optimizing the treatment of acute pain in the emergency department","volume":"70","year":"2017","journal-title":"Ann Emerg Med."},{"issue":"2","key":"2020072304565398300_CIT0007","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.annemergmed.2016.10.014","article-title":"Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial","volume":"70","author":"Motov","year":"2017","journal-title":"Ann Emerg Med."},{"issue":"11","key":"2020072304565398300_CIT0008","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1111\/acem.13245","article-title":"Randomized controlled double-blind trial comparing haloperidol combined with conventional therapy to conventional therapy alone in patients with symptomatic gastroparesis","volume":"24","author":"Roldan","year":"2017","journal-title":"Acad Emerg Med."},{"issue":"4","key":"2020072304565398300_CIT0009","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.ajem.2018.08.056","article-title":"Intravenous lidocaine for renal colic in the emergency department (ED)","volume":"37","author":"Makhoul","year":"2019","journal-title":"Am J Emerg Med."}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/77\/15\/1258\/33520389\/zxaa166.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ajhp\/article-pdf\/77\/15\/1258\/33520389\/zxaa166.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T08:59:04Z","timestamp":1595494744000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/article\/77\/15\/1258\/5864990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,30]]},"references-count":9,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2020,6,30]]},"published-print":{"date-parts":[[2020,7,23]]}},"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxaa166","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,8,1]]},"published":{"date-parts":[[2020,6,30]]}}}