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Current state of opioid stewardship.
Am J Health Syst Pharm. 2020 Apr 01; 77(8):636-643.AJ

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.

Authors+Show Affiliations

Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, and Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.Department of Pharmacy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD.Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32236455

Citation

Ardeljan, L Diana, et al. "Current State of Opioid Stewardship." American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, vol. 77, no. 8, 2020, pp. 636-643.
Ardeljan LD, Waldfogel JM, Bicket MC, et al. Current state of opioid stewardship. Am J Health Syst Pharm. 2020;77(8):636-643.
Ardeljan, L. D., Waldfogel, J. M., Bicket, M. C., Hunsberger, J. B., Vecchione, T. M., Arwood, N., Eid, A., Hatfield, L. A., McNamara, L., Duncan, R., Nesbit, T., Smith, J., Tran, J., & Nesbit, S. A. (2020). Current state of opioid stewardship. American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 77(8), 636-643. https://doi.org/10.1093/ajhp/zxaa027
Ardeljan LD, et al. Current State of Opioid Stewardship. Am J Health Syst Pharm. 2020 Apr 1;77(8):636-643. PubMed PMID: 32236455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Current state of opioid stewardship. AU - Ardeljan,L Diana, AU - Waldfogel,Julie M, AU - Bicket,Mark C, AU - Hunsberger,Joann B, AU - Vecchione,Tricia Marie, AU - Arwood,Nicole, AU - Eid,Ahmed, AU - Hatfield,Laura A, AU - McNamara,LeAnn, AU - Duncan,Rosemary, AU - Nesbit,Todd, AU - Smith,Jacob, AU - Tran,Jackie, AU - Nesbit,Suzanne A, PY - 2020/4/3/entrez PY - 2020/4/3/pubmed PY - 2020/4/3/medline KW - formulary restrictions KW - opioid risk factors KW - opioid safety KW - opioid stewardship KW - opioid-related adverse events KW - pain management SP - 636 EP - 643 JF - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JO - Am J Health Syst Pharm VL - 77 IS - 8 N2 - 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. SN - 1535-2900 UR - https://neuro.unboundmedicine.com/medline/citation/32236455/Current_state_of_opioid_stewardship_ L2 - https://academic.oup.com/ajhp/article-lookup/doi/10.1093/ajhp/zxaa027 DB - PRIME DP - Unbound Medicine ER -