Current state of opioid stewardship

Abstract

Purpose The opioid epidemic continues to result in significant morbidity and mortality even within hospitals where opioids are the second most common cause of adverse events. Opioid stewardship represents one model for hospitals to promote safe and rational prescribing of opioids to mitigate preventable adverse events in alliance with new Joint Commission standards. The purpose of this study was to identify the prevalence of current hospital practices to improve opioid use. Methods A cross-sectional survey of hospital best practices for opioid use was electronically distributed via electronic listservs in March 2018 to examine the presence of an opioid stewardship program and related practices, including formulary restrictions, specialist involvement for high-risk patients, types of risk factors screened, and educational activities. Results Among 133 included hospitals, 23% reported a stewardship program and 14% reported a prospective screening process to identify patients at high risk of opioid-related adverse events (ORAEs). Among those with a prospective screening process, there was variability in ORAE risk factor screening. Formulary restrictions were dependent on specific opioids and formulations. Patient-controlled analgesia was restricted at 45% of hospitals. Most hospitals reported having a pain management service (90%) and a palliative care service providing pain management (67%). Conclusion The absence of opioid stewardship and prospectively screening ORAEs represents a gap in current practice at surveyed hospitals. Hospitals have an opportunity to implement and refine best practices such as access to pain management specialists, use of formulary restrictions, and retrospective and prospective monitoring of adverse events to improve opioid use.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Additional evaluation of the influence of perioperative analgesic strategies on the development of persistent postoperative pain and opioid use would be an invaluable contribution to the literature [2,50,539]. Implementation studies describing successful opioid stewardship programs should be pursued to address practice challenges and increase universal adoption [38,68,540].…”

Survey of Opioid Stewardship Practices in American Society of Health-System Pharmacists (ASHP) Post-Graduate Year 2 (PGY2) Pain Management and Palliative Care (PMPC) Pharmacy Residency Programs

“…Despite the discrepancies in survey responses, there is unanimous acknowledgement of the importance of pharmacist involvement in opioid stewardship across different settings. Pharmacists can provide valuable clinical and operational expertise to the interdisciplinary team that can influence healthcare system/hospital formularies, adverse event monitoring programs and others (4,7). Survey results identified the biggest barriers to pharmacist involvement is personnel and time compensation.…”

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

“…140 Nevertheless, this important yet still developing concept lacks consensus SPECIAL ARTICLE definition and implementation, and is sometimes conflated with institutional administrative superstructures or with clinical pain management approaches. [141][142][143][144] In addition, opioid stewardship programs are institution-based and institution-specific, often focused mainly on prescribing practices, prescribing monitoring, and addiction. [141][142][143][144] Programs are often linked to hospital pharmacy consult services or to clinical pharmacy specialists within hospitals and health systems.…”

“…Last, they are not widely found, and are variably effective. [141][142][143][144] Programs focus on clinicians, administrators, quality assessment personnel, clinical disciplines, administrative structure, organizational policies, tasks, tracking, and reporting. 138,142,145 These are all extremely valuable institutional efforts, but they are not patient-centric, and do not directly address patients and communities at large or the problem of the opioid pool and its consequences.…”