Opioid stewardship can reduce inappropriate prescribing of opioids at hospital discharge

Schug, Stephan A.

doi:10.5694/mja2.50818

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…Discussion with patients about potential risk, and communication of a pain management plan and opioid weaning plans with both patients and community practitioners is recommended as a component of opioid stewardship. 61 Recommendations for monitoring for persistent opioid use or emerging misuse and referral to pain or addiction services should be a component of this plan.…”

Section: Patients At Risk Developing Oudmentioning

confidence: 99%

Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Murnion

Demirkol

2022

Anaesth Intensive Care

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Opioid misuse is common, as is opioid agonist treatment of opioid dependence. Almost 3% of Australians and over 3.5% of those living in New Zealand report misuse of analgesics. Over 50,000 Australians receive opioid agonist treatment with methadone or buprenorphine for management of severe opioid use disorder. The perioperative period is an opportunity to identify pre-existing opioid misuse, and to introduce interventions to reduce the risk of development of opioid use disorder. Challenges of acute perioperative pain management or intensive care management of patients receiving opioid agonist treatment include opioid tolerance and ongoing prescribing of methadone or buprenorphine. There has been some ambiguity about the optimal perioperative management of buprenorphine, a partial agonist at the mu receptor. In this article, a framework to identify emerging opioid misuse problems, identify risk of overdose and to manage the opioid-dependent patient on opioid agonist treatment perioperatively or in the intensive care unit is provided. Diagnostic criteria and risk stratification criteria are presented. Management strategies include trauma-informed care, care planning and care coordination with community practitioners and opioid agonist treatment providers. Continuing methadone or buprenorphine perioperatively with additional opioid and non-opioid analgesia is generally recommended. Increased opioid agonist treatment doses may be required on discharge. An algorithm for decisions about opioid agonist treatment management in the intensive care unit based on the risks of opioid withdrawal and toxicity is considered. Strategies for managing the opioid-dependent patient who is not in treatment are also discussed.

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Section: Patients At Risk Developing Oudmentioning

confidence: 99%

Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Murnion

Demirkol

2022

Anaesth Intensive Care

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“…109 Based on the successes of antimicrobial stewardship, a stewardship program has been proposed as a model to mitigate preventable opioid adverse events in the hospital setting, and also to reduce the risk of long-term opioid use by rationalising duration and supply at discharge. [110][111][112] The US National Quality Forum, with its release of the Opioid Stewardship Playbook, 113,114 proposed seven fundamentals to support stewardship for healthcare organisations and clinicians which are applicable to any healthcare organisation or setting. Several primary care studies in the scoping review directly referred to opioid or controlled substances stewardship models, 40,[61][62][63][64]74 demonstrating many of the recommended fundamentals.…”

Section: Focus Of Activity Description Of Pharmacist Activitymentioning

confidence: 99%

Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities

Jordan

Latif

Mullan

et al. 2021

Brit J Clinical Pharma

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To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.

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“…Opioid stewardship within healthcare institutions is an avenue for guiding quality improvement toward safe prescribing. 8,9 Opioid stewardship programs (OSPs) seek to use interventions within the hospital setting to regulate the prescribing of opioids in an effort to prevent problems, such as persistent use and overdoses. 10,11 However, such programs are scarce: the reported rate of OSPs in U.S. hospitals is only 23%.…”

mentioning

confidence: 99%

Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System

et al. 2022

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ObjectivesOverprescribing to opioid-naive surgical patients substantially contributes to opioid use disorders, which have become increasingly prevalent. Opioid stewardship programs (OSPs) within healthcare settings provide an avenue for introducing interventions to regulate prescribing. This study examined the association of OSP policies limiting exposure on changes in surgery-related opioid prescriptions and patient pain.MethodsWe evaluated policies implemented by an OSP in a large American healthcare system between 2016 and 2018: nonopioid medication during surgery, decrease of available opioid dosage vials in operating rooms, standardization of opioid in-patient practices through electronic health record alerts, and limit to postsurgery opioid supply. Generalized linear mixed effects models examined the association of interventions with outcome changes in 9262 opioid-naive patients undergoing elective surgery. Outcomes were discharge pain, morphine milligram equivalent in the first prescription postsurgery, and opioid prescription refills.ResultsDecreases in all prescription outcomes and discharge pain were observed following onset of OSP interventions (P’s < 0.001). Among individual policies, standardization of in-patient prescribing practices was associated with the strongest decrease in prescribed morphine milligram equivalent. Importantly, there was no evidence of an increase in discharge pain related to any intervention.ConclusionsThis study promotes the potential of OSP formation and policies to reduce opioid prescribing without compromising patient pain. The most effective policy, standardization of in-patient prescribing practices through alerts, suggests that reminding prescribers to re-evaluate the patient’s need is effective in changing behavior. The findings offer considerations for OSP formation and policy implementation across health systems to improve quality and safety in opioid prescribing.

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Opioid stewardship can reduce inappropriate prescribing of opioids at hospital discharge

Cited by 4 publications

References 12 publications

Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Opioid use disorder in anaesthesia and intensive care: Prevention, diagnosis and management

Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities

Evaluation of Policies Limiting Opioid Exposure on Opioid Prescribing and Patient Pain in Opioid-Naive Patients Undergoing Elective Surgery in a Large American Health System

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