The Michigan Opioid Safety Score (MOSS): A Patient Safety and Nurse Empowerment Tool

Journal of PeriAnesthesia Nursing

The Michigan Opioid Safety Score (MOSS) was developed to incorporate patient risk, respiratory rate, and sedation into one bedside score that could be used to improve patient safety during inpatient opioid therapy. Scoring is based on a summation of risk data with objective bedside measures of over-sedation trumping a patient’s subjective reports of pain.

Opioid Overdose Prevention TOOLKIT & Opioid Use Disorder Facts

Substance Abuse and Mental Health Services Administration (SAMHSA)

This toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families, and those recovering from opioid overdose.

  • Scope of the Problem
  • Strategies to Prevent Overdose Deaths
  • Resources for Communities

Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders: TIP 54

Substance Abuse and Mental Health Services Administration (SAMHSA)

This guide equips clinicians with information for treating chronic pain in adults living with a history of substance use. The guide discusses chronic pain management, including treatment with opioids. It also includes information about substance use assessments and referrals. Available at no cost from SAMSHA.

Reducing Adverse Drug Events Related to Opioids (RADEO) Implementation Guide

Society of Hospital Medicine (SHM)

Provides step-by-step guidance to assist hospital teams in implementing a quality improvement program to improve patient safety and reduce opioid-related adverse events for patients receiving opioids, including:

  • Instituting safer opioid prescribing practices resulting in fewer adverse events, like dangerous over sedation, respiratory depression and death
  • Focusing on hospitalized patients, with essential building blocks for developing a quality improvement initiative addressing the inpatient setting
  • Creating a quality improvement project team in your hospital, gaining institutional support and securing buy-in of frontline staff to ensure successful implementation
  • Developing strategies for evaluating current processes, facilitating policy formation, identifying best practices and tracking progress against implementation goals
  • Optimizing care transitions for patients on opioid therapy in the outpatient setting
  • Exploring a customized approach to address the specific needs of your hospital

Pain Management Toolkit: Iowa’s Guide to Opioid Stewardship

Iowa Healthcare Collaborative

Resources is divided into sections that can stand alone for quick reference. Addresses the real-world situations practitioners face in daily patient care (difficult conversations, non-opioid treatment interventions, acute pain treatment, tapering, chronic pain care, managing ED patients, pain control for cancer and palliative care, etc.)

Colorado Alternatives to Opioids (ALTO) Project

Colorado Hospital Association

In 2017, CHA and its partners developed the Colorado Opioid Safety Pilot, a study that was conducted in 10 hospital emergency departments (EDs) over a six-month span with a goal of reducing the administration of opioids in those EDs by 15 percent. The cohort of 10 participating sites achieved an average 36 percent reduction in the administration of opioids during those six months, as well as a 31.4 percent increase in the administration of alternatives to opioids (ALTOs). Based on the success of the pilot, CHA has launched the Colorado ALTO Project to implement this program in all hospital EDs.

E-QUAL Opioids Toolkits: Pain Management and Safe Opioid Use

American College of Emergency Physicians (ACEP); Emergency Quality Network (E-QUAL)

Targeted at EDs concentrating quality efforts to improving safe opioid prescribing; Safe Prescribing Poster, Opioid Checklist, Optimizing the Treatment of Acute Pain in the ED, Alternatives to Opioids, etc.

Implementation of an Opioid Stewardship Program at an Academic Medical Center

American Society of Health-System Pharmacists (ASHP)

As the opioid crisis continues to affect the lives of people around the country health-systems most impacted by the crisis have taken a proactive approach in the fight. Recognizing the need for grassroots leadership to guide responsible opioid prescribing the University of Kentucky HealthCare implemented an Opioid Stewardship Program.

Establishing an Opioid Stewardship Program in Your Health System

The Joint Commission

This 1-hour webinar featured Dr. Jeanmarie Perrone from the University of Pennsylvania Medical Center & Dr. Scott Weiner from Brigham and Women’s Hospital sharing their experiences with setting up programs to encourage safe prescribing of opioids and reducing opioid-related deaths. The speakers shared pearls & lessons learned, with the idea of providing a framework for other systems to implement similar programs as we work towards solutions to the opioid addiction and overdose epidemic.


American Hospital Association (AHA)

The Guide addresses six critical elements that can support users through a process of implementing a data-driven approach to an opioid stewardship program: 1) developing a leadership strategy; 2) conducting an environmental
scan of available resources, existing efforts and available data; 3) selecting measures; 4) setting goals and developing an improvement plan to drive progress on those measures; 5) creating policies and education for care teams; and 6) providing patient education and engaging patients in shared decision-making. We believe that these elements lay the foundation for driving and measuring progress in opioid stewardship.