Assessment of Current Opioid Stewardship Activities and Evaluation of Health Informatics Tools to Reduce Opioid Prescribing

Abstract

Background: Overprescribing opioids has become a public health emergency in which 128 people in the United States die every day after overdosing on opioids. This also poses a problem in the acute care setting, as many institutions do not continually monitor daily opioid administrations. Currently, opioid use in the hospital setting can be tracked using morphine milligram equivalents (MME) calculators. Several studies have shown that monitoring MMEs can help identify patients at risk for overdose death. In particular the CDC recommends using caution when increasing to >50 MME per day, and to avoid or carefully justify increasing doses to >90 MME per day. The CDC has also outlined high risk conditions for opioid related harm including patients >65 years, pre-disposing conditions such as mental health or substance abuse disorders, and previous naloxone use. Through this research project, we will be able to assess our current opioid stewardship activities through a survey presented to pharmacy staff and then discussing health informatics-based options for the monitoring of MMEs in an acute care hospital system. Objective: The primary objective of this study is to assess the current opioid stewardship activities and to discuss the need to implement clinical decision support tools to provide EHR-based opioid prescribing guidelines. Methods: A voluntary survey will be administered to pharmacy staff to assess how pharmacists current screen patients� profiles for pain medication administration and how they currently approach avoiding pain duplication and overprescribing of opioids. Through this survey, we will be able to address: � PDMP review � MEDD calculator use � Long-acting opioid appropriateness � Interdisciplinary communication with provider � Chart review for naloxone use or respiratory depression � PRN opioid order monitoring This survey will provide information for how pharmacists are performing opioid stewardship activities. This information will also be used to discuss current health informatics tools that could be utilized to provide an EHR-based approach to this real-time monitoring for the development of a process to integrate into workflow. Results & Conclusions: In progress