A Survey of Opioid Medication Stewardship Practices at Academic Medical Centers

Phelps, Pamela; Achey, Thomas S.; Mieure, Katherine D.; Cuellar, Lourdes M.; MacMaster, Heidemarie Windham; Pecho, Robert; Ghafoor, Virginia L.

doi:10.1177/0018578718779005

Cited by 14 publications

(14 citation statements)

References 6 publications

(5 reference statements)

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“…Prescriber education and guidelines have been shown to successfully reduce the number of opioids initially prescribed by more than half [ 13 ]. This study showed that more than half of the respondents stated that their hospital did not have a policy for prescriber education, which was similar to a study conducted in the US where only 26.9% of hospitals responded having a policy that requires education of providers and/or caregivers about safe opioid prescribing [ 14 ]. Education of prescribers has been reported in Australia and New Zealand as one of the main opioid stewardship measures (78%) currently implemented.…”

Section: Discussionsupporting

confidence: 73%

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

et al. 2021

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Objective: The objectives of this study are to describe opioid stewardship practices in hospitals being implemented globally, in addition to investigating the attitudes and perceptions of health professionals regarding opioid stewardship in the hospital setting. Methods: A survey was developed by the research team to ask about participants’ attitudes and perceptions regarding opioid stewardship practices. The survey was piloted for performance by five independent third-party healthcare professionals prior to being made available online, being hosted using Research Electronic Data Capture software, with invitations distributed by the International Pharmaceutical Federation (FIP). Descriptive analyses were used to describe the features of the study, and responses obtained from the survey were further categorised into subgroups separating answers relating to attitudes and perceptions, and policies and regulations. Results: Overall, there were 50 respondents from 18 countries, representing an 8% response rate from the FIP hospital pharmacy section mailing list. In total, 33/50 (66%) participants agreed opioids are overused nationally, with 22/49 (45%) agreeing they are overused at their workplace. Furthermore, 32/50 (64%) agreed the opioid crisis is a significant problem nationally, and 44/50 (88%) agreed opioid stewardship would reduce problems associated with the opioid crisis. Policies to educate providers about safe opioid prescribing were uncommon, not exhibited in 26/46 (57%) of hospitals, with all EMR and SE Asia hospitals not displaying this policy. Policy for investigation of narcotic discrepancies was present in 34/46 (74%) of hospitals, and there was a policy for reporting discrepancies at 33/46 (72%) hospitals. Conclusion: In conclusion, healthcare professionals in the American region are more likely to perceive the opioid crisis as a problem, as opposed to those from the European region. Regardless of the presence or absence of a crisis, the implementation of further opioid education and stewardship practices are necessary globally and will contribute to safer prescribing and utilisation practices in hospitals.

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Section: Discussionsupporting

confidence: 73%

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

et al. 2021

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“…The ‘deprescribing’ of opioids needs to address reducing the initial prescription of opioids, but also how to support the cessation of opioids whilst still providing access to appropriate pain management. Opioid mitigation strategies have begun, for example, national initiatives , opioid stewardship programmes and up‐scheduling of codeine in Australia and Italy . However, research on opioid mitigation strategies specific to the needs of patients with chronic noncancer pain is needed.…”

Section: Discussionmentioning

confidence: 99%

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

et al. 2020

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Mathieson S, ). What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies (Review). J Intern Med 2020; 287: 458-474.Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.

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“…Some institutions have implemented opioid stewardship programs (OSPs) to achieve these goals. Core pillars of OSPs include interprofessional collaboration on protocols and services related to multimodal pain management, education on opioid prescribing and stewardship to staff and providers, education to patients, caregivers and community members on safe opioid use and disposal, opioid-related risk reduction, and data analysis and reporting of related quality metrics [ 38 , 66 , 68 , 519 , 520 , 521 , 522 ]. An expert panel has proposed quality indicators for measuring opioid stewardship interventions in hospital and emergency settings.…”

Section: Interprofessional Collaboration In Sustaining Perioperatimentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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A Survey of Opioid Medication Stewardship Practices at Academic Medical Centers

Cited by 14 publications

References 6 publications

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

A Global Survey on Opioid Stewardship Practices in Hospitals: A Cross-Sectional Pilot Study

What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta‐regression of observational studies

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

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