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Shifting Our Focus to Preventing Negative Outcomes from Opioids

Preventing negative outcomes from the treatment associated with a workplace injury is just as critical as preventing the injury from happening.
By: | May 18, 2017 • 6 min read

Providing people who want to work, the opportunity to work is not only important to individual families but also the economy. When workers are injured, they may lose that opportunity. Preventing work injuries from happening in the first place is far and away the best way to keep workers from becoming injured workers. When injuries do happen, it is imperative for all involved, to focus on getting workers healthy and back to their lives.

Once an injury has taken place, a lot can happen during the course of treatment that ultimately will lead to positive or negative outcomes. Preventing negative outcomes from the treatment associated with an injury is just as important as preventing the workplace injury in the first place. To prevent injuries we implement and encourage proper training, awareness and safety protocols. Similar protocols should be used to prevent negative outcomes during the course of treatment so injured workers can return to the most productive life possible.

How can we prevent negative outcomes from happening in the course of treatment of an injured worker? If the course of treatment was process mapped, we might find several gaps in care that could affect outcomes. Importantly, a major gap in care for many would relate to the opioid epidemic. The Centers for Disease Control and Prevention (CDC) report that as many as 1 in 4 patients receiving long-term opioid therapy in a primary care setting, struggle with addiction.1 And, “we now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths.”2 At their best, opioids are valuable tools in mitigating intense acute pain helping injured workers get through the toughest portions of their pain and onto the road to recovery. At their worst, opioids are an intensely addictive therapy that has led to 91 Americans dying every day from overdoses.2

While recent initiatives such as improving access to care for those addicted to opioids, and expanding access to the life-saving drug naloxone used in opioid overdose are important steps towards addressing the epidemic for those that have already developed a negative outcome, we also need to focus on preventing negative outcomes from happening in the first place. To do this, it has become clear that there needs to be a multifaceted approach that identifies a goal and establishes a methodology to achieve that goal for the injured worker. Process models would challenge us to capitalize on available resources and remove wasted steps to be able to identify, maintain and sustain process improvement towards improving opioid epidemic related problems. The process of treatment within Workers’ Compensation is a team effort among many people who influence the care an injured worker receives and as such an approach that utilizes each team member’s expertise as a resource will be useful.

Stephanie Labonville, PharmD, CPE, BCPS, Director of Clinical Operations

The pharmacist role is an evolving and often underutilized available resource that can be instrumental in a multifaceted approach towards preventing negative outcomes. As experts in medication, pharmacists’ skills and knowledge are valuable resources and they have the ability to contribute to integrated care teams by detecting and resolving or preventing drug related problems, helping to ensure the safe and efficacious use of medicines and providing comprehensive drug information to patients and other health care professionals, thereby reinforcing prevention of negative outcomes.

As an industry, we must focus on our role in appropriate and safe pain management. This focus must take into consideration the CDC’s calling on dispensing pharmacists to be on the front lines of addressing prescription opioid abuse and overdose.3 Dispensing pharmacists as part of a Workers’ Compensation PBM must take this front-line role to a value-added level and develop specific program solutions focused on opioid related problems such as Prescription Drug Monitoring Program (PDMP) reviews and education of injured workers and communication with their physicians regarding high-risk drug combinations, high risk opioid doses and safer alternative treatment regimens.

Some drug combinations can be extremely dangerous. For example, there has been much written about the “holy trinity” of drugs: opioids, benzodiazepines and carisoprodol (Soma) and the serious danger inherent in taking 2 or 3 of these together.4,5 Can we really afford to use a pharmacy or PBM that doesn’t have a standardized approach to this combination or one who does not take action before the combinations of medications are dispensed? We need specific programs that reach out to the patient and prescribing physicians on these specific risky drug combinations prior to their dispensing.

Pharmacists who can access state PDMPs can help identify patients at increased risk of overdose, such as those taking high dosages or obtaining opioids from multiple prescribers. They can then help monitor the patient and their prescriptions allowing for proactive consultation with the injured worker and prescriber prior to dispensing high-risk medications.

In addition to consulting with physicians regarding opioid addiction and high-risk drug combinations, it is important for the pharmacist to be able to alert a prescriber to pertinent legislative rule(s) for their state and their patient’s morphine milligram equivalent (MME) before the pills are dispensed. Choosing a PBM with this capability can be critical to preventing negative outcomes.

As injured workers are educated about what medications may work best for them as well as potential risks of various medications or combinations of medications, they are provided the opportunity to become advocates for themselves. We need to ensure that dispensing pharmacists have experienced insight into pain management within Workers’ Compensation, which they can then use to educate patients. Pharmacists as part of the injured worker’s treatment team can use a variety of ways to educate patients including direct phone calls and subsequent informational pieces that address pain management e.g., “If not opioids, then what?”

Many injured workers are scared that their pain will be unmanageable without opioids. Learning that outcomes and pain management are often improved through the use of tapers, other non -addictive medications, non-drug therapies like; cognitive behavior therapy (CBT), massage, movement therapies, socialization, healthier food and lifestyle decisions, will provide the injured workers the resources and support to get on the road to recovery and return them to what they deserve: the opportunity to return to a productive life. The equipped dispensing pharmacist must be an integral member of the medical treatment team to make that a reality.

We can, as an industry, work towards this goal of keeping workers participating in the workforce and in their life by ensuring that we involve knowledgeable, experienced dispensing pharmacists in the treatment plan of our complex cases before a potentially risky pain medication regimen is determined, prescribed and dispensed.

Let’s help protect our most important national resource: our workers before they become statistics, by focusing on prevention as well as management of this problem.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Specialty Solutions Rx. The editorial staff of Risk & Insurance had no role in its preparation.




Specialty Solutions Rx is a full service workers’ compensation PBM that was designed to proactively and effectively address opioids and other high risk medications.

Risk Report: Manufacturing

More Robots Enter Into Manufacturing Industry

With more jobs utilizing technology advancements, manufacturing turns to cobots to help ease talent gaps.
By: | May 1, 2018 • 6 min read

The U.S. manufacturing industry is at a crossroads.

Faced with a shortfall of as many as two million workers between now and 2025, the sector needs to either reinvent itself by making it a more attractive career choice for college and high school graduates or face extinction. It also needs to shed its image as a dull, unfashionable place to work, where employees are stuck in dead-end repetitive jobs.

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Added to that are the multiple risks caused by the increasing use of automation, sensors and collaborative robots (cobots) in the manufacturing process, including product defects and worker injuries. That’s not to mention the increased exposure to cyber attacks as manufacturers and their facilities become more globally interconnected through the use of smart technology.

If the industry wishes to continue to move forward at its current rapid pace, then manufacturers need to work with schools, governments and the community to provide educational outreach and apprenticeship programs. They must change the perception of the industry and attract new talent. They also need to understand and to mitigate the risks presented by the increased use of technology in the manufacturing process.

“Loss of knowledge due to movement of experienced workers, negative perception of the manufacturing industry and shortages of STEM (science, technology, engineering and math) and skilled production workers are driving the talent gap,” said Ben Dollar, principal, Deloitte Consulting.

“The risks associated with this are broad and span the entire value chain — [including]  limitations to innovation, product development, meeting production goals, developing suppliers, meeting customer demand and quality.”

The Talent Gap

Manufacturing companies are rapidly expanding. With too few skilled workers coming in to fill newly created positions, the talent gap is widening. That has been exacerbated by the gradual drain of knowledge and expertise as baby boomers retire and a decline in technical education programs in public high schools.

Ben Dollar, principal, Deloitte Consulting

“Most of the millennials want to work for an Amazon, Google or Yahoo, because they seem like fun places to work and there’s a real sense of community involvement,” said Dan Holden, manager of corporate risk and insurance, Daimler Trucks North America. “In contrast, the manufacturing industry represents the ‘old school’ where your father and grandfather used to work.

“But nothing could be further from the truth: We offer almost limitless opportunities in engineering and IT, working in fields such as electric cars and autonomous driving.”

To dispel this myth, Holden said Daimler’s Educational Outreach Program assists qualified organizations that support public high school educational programs in STEM, CTE (career technical education) and skilled trades’ career development.

It also runs weeklong technology schools in its manufacturing facilities to encourage students to consider manufacturing as a vocation, he said.

“It’s all essentially a way of introducing ourselves to the younger generation and to present them with an alternative and rewarding career choice,” he said. “It also gives us the opportunity to get across the message that just because we make heavy duty equipment doesn’t mean we can’t be a fun and educational place to work.”

Rise of the Cobot

Automation undoubtedly helps manufacturers increase output and improve efficiency by streamlining production lines. But it’s fraught with its own set of risks, including technical failure, a compromised manufacturing process or worse — shutting down entire assembly lines.

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More technologically advanced machines also require more skilled workers to operate and maintain them. Their absence can in turn hinder the development of new manufacturing products and processes.

Christina Villena, vice president of risk solutions, The Hanover Insurance Group, said the main risk of using cobots is bodily injury to their human coworkers. These cobots are robots that share a physical workspace and interact with humans. To overcome the problem of potential injury, Villena said, cobots are placed in safety cages or use force-limited technology to prevent hazardous contact.

“With advancements in technology, such as the Cloud, there are going to be a host of cyber and other risks associated with them.” — David Carlson, U.S. manufacturing and automobile practice leader, Marsh

“Technology must be in place to prevent cobots from exerting excessive force against a human or exposing them to hazardous tools or chemicals,” she said. “Traditional robots operate within a safety cage to prevent dangerous contact. Failure or absence of these guards has led to injuries and even fatalities.”

The increasing use of interconnected devices and the Cloud to control and collect data from industrial control systems can also leave manufacturers exposed to hacking, said David Carlson, Marsh’s U.S. manufacturing and automobile practice leader. Given the relatively new nature of cyber as a risk, however, he said coverage is still a gray area that must be assessed further.

“With advancements in technology, such as the Cloud, there are going to be a host of cyber and other risks associated with them,” he said. “Therefore, companies need to think beyond the traditional risks, such as workers’ compensation and product liability.”

Another threat, said Bill Spiers, vice president, risk control consulting practice leader, Lockton Companies, is any malfunction of the software used to operate cobots. Then there is the machine not being able to cope with the increased workload when production is ramped up, he said.

“If your software goes wrong, it can stop the machine working or indeed the whole manufacturing process,” he said. “[Or] you might have a worker who is paid by how much they can produce in an hour who decides to turn up the dial, causing the machine to go into overdrive and malfunction.”

Potential Solutions

Spiers said risk managers need to produce a heatmap of their potential exposures in the workplace attached to the use of cobots in the manufacturing process, including safety and business interruption. This can also extend to cyber liability, he said.

“You need to understand the risk, if it’s controllable and, indeed, if it’s insurable,” he said. “By carrying out a full risk assessment, you can determine all of the relevant issues and prioritize them accordingly.”

By using collective learning to understand these issues, Joseph Mayo, president, JW Mayo Consulting, said companies can improve their safety and manufacturing processes.

“Companies need to work collaboratively as an industry to understand this new technology and the problems associated with it.” — Joseph Mayo, president, JW Mayo Consulting

“Companies need to work collaboratively as an industry to understand this new technology and the problems associated with it,” Mayo said. “They can also use detective controls to anticipate these issues and react accordingly by ensuring they have the appropriate controls and coverage in place to deal with them.”

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Manufacturing risks today extend beyond traditional coverage, like workers’ compensation, property, equipment breakdown, automobile, general liability and business interruption, to new risks, such as cyber liability.

It’s key to use a specialized broker and carrier with extensive knowledge and experience of the industry’s unique risks.

Stacie Graham, senior vice president and general manager, Liberty Mutual’s national insurance central division, said there are five key steps companies need to take to protect themselves and their employees against these risks. They include teaching them how to use the equipment properly, maintaining the same high quality of product and having a back-up location, as well as having the right contractual insurance policy language in place and plugging any potential coverage gaps.

“Risk managers need to work closely with their broker and carrier to make sure that they have the right contractual controls in place,” she said. “Secondly, they need to carry out on-site visits to make sure that they have the right safety practices and to identify the potential claims that they need to mitigate against.” &

Alex Wright is a U.K.-based business journalist, who previously was deputy business editor at The Royal Gazette in Bermuda. You can reach him at [email protected]