A Team-Based Approach to Combatting the Opioid Epidemic: Roles for Pharmacists

Transcription

1 A Team-Based Approach to Combatting the Opioid Epidemic: Roles for Pharmacists Elise A. Dasinger, PharmD, MHA Fellow, VA Quality Scholars Program Birmingham VA Medical Center & The University of Alabama at Birmingham

2 Disclosure & Disclaimer Statements Disclosure: I have no actual or potential conflict of interest in relation to this presentation. Disclaimer: The views expressed in this presentation are those of the presenter and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government. 2

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4 Pharmacists Can Help HOSPITAL EDUCATION COMMUNITY 4

5 PROVIDING EDUCATION 5

6 VA s Success with Pharmacist-Led Education Academic Detailing: A service-oriented outreach education for health care professionals by health care professionals; leveraging the one-on-one communication approach of pharmaceutical industry detailers combined with the evidence-based, noncommercial aims of academic groups, research, and development centers. Provides access to balanced evidence-based information in an effective and impactful way Quality-oriented approach that helps providers make appropriate clinical decisions, ideally based on the best available safety, efficacy, and costeffectiveness data Provider Patient Academic Detailing Admin; Leaders 6

7 Opioid Use Disorder Pain Specific Provider Resources Materials Educational Moving Materials Beyond Opioids A VA Clinician s Guide (2017) VANational Academic Detailing Service S.T.O.P. P.A.I.N. Educational Materials Pain/Opioid Safety Initiative Pain/Opioid Safety Initiative Transforming the Treatment of Chro Pain/Opioid Safety Initiat Headache Provider Materials Transforming the Treatment of Chronic P Acute Pain Management Moving Beyond Opioids Opioid Safety A VA Clinician s Guide (2017) Opioid Use Dis VA Educational Guide (2017) Opioid Use Disorder Provider Materials A Suicide VA Clinician and P of Opioid Use D Provider Materials Opioid Use Disorder Transforming the Treatment of Pain A Quick Reference Guide (2017) Transforming the Treatment Opioid of Pain Use Dis A Quick Reference Guide Identification (2017) Opioid Medica Transforming Acute Pain the Treatment of Chronic Pain Do You Know Moving Opioids Beyond Are Not Always Opioids the Answer A VA Clinician s Guide (2017) Opioid Use Disorder Opioid Taper Decision Tool H Identification and Management of Opioid Use Disorde S Opioid Taper Decision Tool Patient Materials Opioid Use Opioid Use Disorder A VA Clinician s Guide to Identification and Managem of Opioid Use Disorder (2016) H S VA Academic Detailing Service Educational Material Catalog STOP PAIN Materials Patient Materials Fentanyl & Carfentanil 7

8 Academic Detailing : Impact on Veterans > 100 MEDD Positive Impact? YES! 8

9 EMERGENCY DEPARTMENT PRESCRIBING Education: Acute Pain Campaign Identify Resources Aligning Practice with Guidelines Leadership Support Identify Barriers 9

10 Leadership Support Meet with facility leadership Assess baseline culture/feasibility of a new practice Identify a champion from the emergency department to drive project Engage key staff Review possible facility barriers from the perspective of leadership Leverage leadership to raise awareness of missing resource elements 10

11 Identify Resources Non-pharmacologic therapies & non-opioid pharmacotherapy Can ED providers directly consult specialists or refer to outside resources? Are there local restrictions on formulary products? Pain Dashboards (QI Measures) # of patients prescribed opioids in the ED New starts on long acting opioids Duration of the opioid prescription (> 5 days) New opioid prescriptions in patients on benzodiazepines New benzodiazepine prescription in patients on chronic opioids Operational Clinical Quality Improvement Opioid Measures (Appendix B) in CDC Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain 11

12 Identify Barriers Emergency Department Providers Ability to order non-opioid therapies Ensuring the ED provider has time to review alternatives to opioids Challenge of managing the demands of patients in the ED expecting opioid prescriptions Differences in prescribing between full time providers compared to contracted providers 12

13 Aligning Practice with Guidelines Determine which guideline recommendations to implement Prioritize what will be implemented Repeat visits to measure willingness to commit to behavior change and adopt new practice Follow-up with priority providers Monitor progress using QI measures and other data Highlight successes, share stories that change lives! 13

14 HOSPITAL SETTING Pharmacist-Led Opioid Exit Plan (OEP) 14

15 Pharmacist-Led Opioid Exit Plan (OEP) Pharmacists guide appropriate therapeutic selection of opioids for pain management Strength and quantity written on discharge Staffing Trained staff pharmacist or clinical pain management pharmacist Student pharmacist(s) for discharge counseling Time Commitment Interdisciplinary rounds: min/day Personalized postop pain management plan: min/patient Discharge counseling: 1-4 hours per day Follow-up: 2 days/week up to 3-4 hours/day Genord C, Frost T, Eid D. Opioid exit plan: A pharmacist's role in managing acute postoperative pain. J Am Pharm Assoc (2003). 2017;57(2S):S92-S98. 15

16 COMMUNITY SETTING Corresponding Responsibility The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. 21 CFR

17 Pharmacists in the Community Pharmacists are frequently mentioned in opioid risk reduction activities Educate patients Support safe medication storage and disposal Distribute naloxone (Ala. Code ) Last Defense against high-risk medication use Opioid Rx Limits at the Pharmacy Counter State: None Insurance: Ex. BCBS acute fill Company: Ex. Walmart acute fill Barriers for Community Pharmacists Workflow processes ( and time) Prescriber-pharmacist-patient communication PharmacistRespond.org 17

18 Drug Take Back Day October 27, :00 AM to 2:00 PM Posters available on website Locations available on website 18

19 Additional Recommended Opioid Resources CDC Quality Improvement and Care Coordination: Implementing the CDC Guideline for Prescribing Opioids for Chronic Pain Evidence-Based Strategies for Preventing Opioid Overdose: What s Working in the United States VHA Pain Management Opioid Safety Clinical Tools Resources Encouraging Safe Prescription Opioid & Naloxone Dispensing PharmacistRespond.org Michigan Opioid Prescribing Engagement Network 19