ASHP InterSections ASHP InterSections

April 30, 2019

ASHP Joins the National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic as a Sponsoring Member

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I AM PLEASED TO SHARE WITH YOU THAT ASHP has become a sponsoring member of the National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic. The other Collaborative Sponsors are:

  • Accreditation Council for Graduate Medical Education
  • Aetna
  • American Hospital Association
  • American Medical Association
  • Arnold Ventures
  • Association of American Medical Colleges
  • Centers for Disease Control and Prevention
  • CDC Foundation
  • Centers for Medicare and Medicaid Services
  • Council of Medical Specialty Societies
  • Federation of State Medical Boards
  • HCA Healthcare
  • National Institute on Drug Abuse
  • Robert Wood Johnson Foundation
  • Substance Abuse and Mental Health Services Administration

The mission of the Action Collaborative is to “convene and catalyze public, private, and non-profit stakeholders to develop, curate, and disseminate multi-sector solutions designed to reduce opioid misuse and improve outcomes for individuals, families, and communities affected by the opioid crisis.”

ASHP and our 50,000 members who serve as direct patient care providers in hospitals, health systems, rehabilitation centers and ambulatory clinics will bring a great deal of expertise to the Collaborative and play a major role to mitigate and end the opioid epidemic on behalf of our patients and communities, while ensuring that our patients receive appropriate pain management.

ASHP will serve on the Action Collaborative’s Opioid Prescribing Guidelines and Evidence Standards Working Group, and will also be providing insights and expertise to the Collaborative’s Health Professional Education and Training Working Group; Prevention, Treatment, and Recovery Services Working Group; and Research, Data, and Metrics Needs Working Group.  As part of our initial work with the Collaborative, we have made several commitments that include but are not limited to:

  • Creation and dissemination of patient and prescriber education on pain management and opioid abuse mitigation best practices.
  • Enhanced patient access to evidence-based treatment for opioid use disorder through increased utilization of pharmacists on the healthcare team.
  • Standardization of a framework for pain stewardship to coordinate pain management, opioid prescribing, and use of non-opioid therapies.
  • Coordination of care among patients, caregivers, and healthcare professionals through the use of standardized patient-specific pain management and substance use disorder treatment plans.
  • Improvement of interoperability, artificial intelligence, and clinical decision support in healthcare information systems.
  • Identification of performance and quality metrics to assess impact.
  • Stimulating research on pain and opioid use disorders and their respective pharmacologic and non-pharmacologic treatments.
  • Advancing efforts to prepare the pharmacy workforce through pharmacy education and professional development programs.

ASHP has also been actively involved in numerous public and private sector efforts to address the opioid crisis through the leadership of pharmacists and has worked diligently across a number of fronts to identify enduring solutions, including advocating for better access to medication-assisted treatment. We had the pleasure of working with the White House Office of National Drug Control Policy and attending the ceremony to commemorate the signing of H.R. 6, the “SUPPORT for Patients and Communities Act,” bipartisan legislation to combat the opioid crisis in October. ASHP will also continue to pursue policies that further support the vital roles pharmacists play as patient care providers in the treatment of acute and chronic conditions, including opioid and substance-use disorders.

You can find additional ASHP resources on our website, including:

We look forward to sharing more about our work with the National Academy of Medicine Action Collaborative on Countering the U.S. Opioid Epidemic and on ASHP’s ongoing efforts surrounding the opioid crisis, including creating various tools, education, and resources to support you in your practice.

Thank you for being a member of ASHP, and for everything that you do for your patients.

Sincerely,

Paul

December 18, 2018

ED Pharmacists Keep Opioid-Naive Patients Naive

ED pharmacists Zachary Brent, Pharm.D., BCPS, and Julie Bennett, Pharm.D., MBA, BCPS, discuss opioid metrics.

IN THE EMERGENCY DEPARTMENT (ED) of Baptist Memorial Hospital in Memphis, Tenn., an innovative opioid stewardship program is showing real promise in keeping opioid prescriptions to a minimum while making sure patients are comfortable and pain-free. The program’s primary goal is to keep opioid-naive patients naive.

Opioids in the ED

“Opioids are an increasing problem in the ED, not because pharmacists are seeing so many more overdoses — those are often treated by EMTs — but because the ED is often where a patient is first exposed to opioids,” explained Julie Bennett, Pharm.D., M.B.A., BCPS, a pharmacist who works in Baptist Memorial Hospital’s bustling ED. “We realized that if we could find a way to eliminate that first exposure, then we could make a significant impact on the opioid crisis.”

With the full support of Baptist Memorial’s ED physicians and leadership, Dr. Bennett and Zachary Brent, Pharm.D., BCPS, also an ED pharmacist at Baptist Memorial, set out to create an opioid stewardship program that offers opioid alternatives to patients.

The two pharmacists, both members of ASHP, began the project in January 2017 by collecting data on opioid usage in Baptist Memorial’s ED. They chose milligrams of morphine equivalents per 100 emergency department patient visits as the primary metric. The data showed that in January 2017 the ED staff was giving 120 mg morphine equivalents per 100 ED patient visits. “This was sobering,” said Dr. Brent. “We were giving a dose of opioids to one out of every four patients in the ED.”

Opioid Alternatives

To reduce opioid dispensing, the hospital’s pharmacy team created an opioid stewardship program based on a program implemented at the Swedish Medical Center in Englewood, Colo. First, the Baptist Memorial pharmacy team identified five conditions that are typically treated with opioids: chronic abdominal pain, headache/migraine, renal colic, extremity fractures/joint dislocations, and musculoskeletal pain. The team then provided physicians with non-opioid alternative treatment options for each condition.

Dr. Bennett orders medications from an automated dispensing system.

“Treatment options are broken down into first-, second- and third-line options,” said Dr. Brent. “For example, first-line treatment for headache/migraine might include a liter of saline plus oxygen, ketorolac, ketamine, or lidocaine injections. A physician might choose one, two, or even three of these options.”

He noted that many of the first-line options are common OTC pain medications, but in IV form. “All of the treatment options are built into our computer physician order entry system so our physicians can easily access and order these alternative pain medications,” said Dr. Brent. “Most of the alternative options are also stocked in our automated dispensing cabinets in the ED to allow for quick retrieval by nurses.”

If an opioid is needed, then the pharmacy team will try to use the lowest effective dose. “If patients come in on opioids, that’s fine, but it doesn’t necessarily mean that we are going to give them opioids while they are in our ED,” said Dr. Brent. “The alternative medications we use tend to work quicker and more effectively to alleviate patients’ pain.”

For example, Dr. Bennett recalled a recent situation where a patient who used morphine and oxycodone at home for a certain condition wanted a prescription from the ED pharmacist to alleviate pain caused by her shoulder bursitis. “She already had topical lidocaine patches and creams and every other alternative I could think of at home,” said Dr. Bennett, who ultimately recommended a nonsteroidal anti-inflammatory drug called ketorolac. The patient remembered that she received ketorolac for a dental procedure and that it had really helped with the pain.

Communication and Education

Soon after rolling out the new opioid stewardship program, the pharmacists experienced a bit of pushback from physicians who were used to ordering opioids and from patients who expected to get them. The pharmacy team used a combination of communication and education to demonstrate why opioid alternatives can often be a better option.

ED physician Katrina Hutton, D.O., and Dr. Bennett talk about opioid alternatives for a patient being discharged.

On the patient side, the pharmacy team assisted nurses with answering patients’ questions about the alternative medications and made sure that patients’ pain needs were always being met. “There were many times when I was called to a room to explain to a patient how the alternative medication works and why it is better than an opioid,” explained Dr. Brent. “Sometimes the patient was satisfied with the explanation, and other times they weren’t.” He believes the conversations with patients helped them understand that the providers in the ED were trying to do what was best for them, instead of just defaulting to using opioids.

Although the physicians were excited about the change and enthusiastic about providing more appropriate care for their patients, “it was still difficult for them to curb their opioid use, since it was a habit for them to order opioids,” said Dr. Brent. “Once our providers knew they had support [from hospital leadership], and we provided them with the order sets and educated the nurses about opioid alternatives, they were all in.”

Satisfied Patients, Satisfied Providers

As a result of implementing the opioid stewardship program in the ED at Baptist Memorial, opioid use decreased by 73 percent. Where previously one out of four patients received a dose of an opioid in the ED, the number has now dropped to 1 out of 10. Patient satisfaction with how they felt their pain was being addressed increased by around 30 percent.

Dr. Brent believes the entire team of ED pharmacists, physicians, and nurses at Baptist Memorial has done a great job of communicating to the patient why they are being given an opioid alternative. “We are all focused on taking care of patients effectively and efficiently,” said Dr. Brent. “Through the opioid alternative program, pharmacists are providing physicians and nurses with the support to do that. ED pharmacists are in the perfect position to partner with our providers to give them the tools needed to take care of patients appropriately.”

 

By Ann Latner

 

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