Envision’s Richard Teames, M.D., and Team Lower Opioid Use, Improve Patient Satisfaction with New Protocol


Envision Physician Services
Envision Physician Services
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With the nation facing an opioid crisis, Envision clinicians are dedicated to providing safer pain management solutions for patients. Richard Teames, M.D., Director of Regional Anesthesia at John Peter Smith (JPS) Hospital in Fort Worth, Texas, is one of the many physicians working with our hospital and health system partners to develop solutions that reduce the use of opioids and improve patient satisfaction.

Dr. Teames and the team at JPS have been using a new order set since the fall of 2018, and they have lowered opioid use by 22 percent and increased Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHP) scores by 19 percent.

The order set minimizes opioid usage for all pain conditions, including post-surgical pain. The set contains acetaminophen, gabapentin, Lyrica, muscle relaxers, ketamine and intravenous (IV) lidocaine among other medications. Dr. Teames said the ubiquitous use of ketamine in the order set is a newer pain management approach. It is currently being used on every floor at JPS Hospital.

Safe and Effective Alternative Treatments to Opioids

“Ketamine has traditionally been utilized in the Operating Room as an analgesic,” Dr. Teames said. “But at very low doses, it is a safe and effective way to manage pain. It doesn’t depress the respiratory system, lower blood pressure or carry the addictive properties that are associated with opioids.” 

Unlike the use of ketamine for sedation, when administered for pain management, it is given at a lower dose and administered slowly during a 15 to 30 minute period.

In addition, the team eliminated intravenous (IV) opioid administration for all but a select few types of patients and medical conditions. This is because IV opioids raise the risk of developing opioid-induced hyperalgesia – increased sensitivity to pain, which can increase the risk a patient will want to manage pain with opioids. Dr. Teames said the team only administers opioids orally and for breakthrough pain.

Another innovative modality in the pain management toolbox is IV lidocaine, a local anesthetic. Dr. Teames said it has effective anti-inflammatory properties.

“A lot of these alternative medications do a great job of reducing inflammation, which helps manage pain – whereas opioids just alter the perception of it. Currently, our patients don’t ask for opioids as often because they find their pain levels to be tolerable and manageable.”

A Commitment to Quality and Patient Safety

With the success of the program at JPS Hospital, Dr. Teames has been incorporating the protocol into his educational lectures around the nation.

“Every four minutes, one person in America dies of an opioid overdose. We must share best practices with one another and work together to drive change. Clinical quality, patient safety and patient satisfaction are of the utmost importance. People have to know that there are safe, effective, alternative ways to manage pain without turning to opioids,” he said.

During the next few weeks, Dr. Teames will develop training modules and short lectures about the program and include them as part of the health system’s pain management approach.

In addition, Dr. Teames recently received the Fort Worth Business Press 2019 HealthCare Heroes award for his pain management initiative and commitment to providing quality patient care.