The ALTO Program: Alternatives to Opioids in the ED

By: Jody Roeber, RN, MSN
Chief Clinical Officer

Colorado has the 12th highest rate of abuse of prescription opioids in the United States (CHA, 2017). Last year the Colorado Hospital Association (CHA) introduced the ALTO program into ten hospital emergency departments across the state. The program is designed to decrease the unnecessary use of opioids, and ultimately one of the pathways to abuse and addiction. Participating hospitals were able to decrease the use of narcotics by 31-46% with no reduction in patient satisfaction scores (CHA 2018).

Delta County Memorial Leadership has chosen to participate in this project and believes this is a high priority for our community and the people we serve. The hospital is actively involved in the development of a community Opioid Task Force and is in the pre-launch phase of the ALTO program.

In 2017, Colorado ACEP (American College of Emergency Physicians) developed Opioid Prescribing and Treatment Guidelines using algorithms based on pain pathways. For each source of pain, they prescribe a set of drugs or treatments, always starting with non-narcotics, progressing to opioids as the last resort. The Emergency Departments that participated in the pilot programs state that they are providing better care with decreased risk.

Preparing the hospital and community for the ALTO program is a huge undertaking requiring nearly every department to work together. Pharmacy, purchasing, IT, marketing, physicians and nurses all have to work together to develop protocols, orders, and community outreach and awareness of changes in prescribing and expectations. Medications not typically used for pain relief are now being utilized with very positive results: Topical/IV lidocaine, low dose Ketamine, Toradol, Tylenol, nitrous oxide, Haldol, Benadryl, and a number of antiemetics can be used with positive results. Trigger point injection is also an intervention, in which lidocaine is injected directly into a nerve bundle or muscle fascia. It can relieve muscle tension and spasm, and works well for the release of scalp tension headaches and other muscle pain.

CHA (2018), Colorado Hospital Association, Colorado Opioid Safety Pilot Results Report, retrieved from Opioid Safety | Colorado Hospital Association