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Pattullo C, Suckling B, Salanowski J, Donovan P, Hall L. Describing the acceptability and use of an opioid stewardship self-assessment tool in real-world settings. Res Social Adm Pharm 2024; 20:203-208. [PMID: 38049350 DOI: 10.1016/j.sapharm.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND The Stewardship Framework (Framework) was developed by an expert clinician group and was designed to provide a mechanism for continuous monitoring of improvement in opioid prescribing in acute hospitals. The aim of this study was to modify the Framework into an Opioid Stewardship Self-Assessment Tool (Self-Assessment Tool), and pilot test the acceptability and its use in a variety of acute hospital settings. METHODS The Framework was converted into the Self-Assessment Tool to allow hospitals to undertake a gap analysis of their current opioid stewardship activities. To participate hospitals were required to establish a small team and complete the Self-Assessment Tool. Participating sites were recruited using purposive sampling. Responses were tabulated and coded to enable assessment. 'Acceptability' was defined as the completion of the Self-Assessment Tool (response rate, proportion of questions answered) and responder feedback relating to its content. The use of the Tool was categorised based on the level of detail of responses. RESULTS Nineteen of the 20 facilities approached, agreed to participate. The 16 sites which established a small team to facilitate survey completion are included in the final analysis. The overall response rate was 96 % (413/432) for the (27 survey questions across 16 participating sites), 4 % (19/432) of questions were left unanswered or were not interpretable by the study team. Opportunities were identified to enhance the use of the Self-Assessment Tool, particularly to support its potential to assist reflection and planning of local strategies. CONCLUSION This study demonstrated that the Self-Assessment Tool was an acceptable method of assessing a facility's opioid stewardship capabilities in a real-world setting. The next iteration will be modified using the insights on how the Tool was used by study participants.
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Affiliation(s)
- Champika Pattullo
- Safety and Implementation Service, Lower Ground Floor, James Mayne Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Queensland, 4006, Australia; School of Public Health, University of Queensland, Herston, Queensland, Australia.
| | - Benita Suckling
- Medication Safety Pharmacist, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Julia Salanowski
- Clinical Pharmacist, Analgesic Stewardship Pharmacist, Pharmacy Department, Barwon Health, Victoria, Queensland, Australia
| | - Peter Donovan
- Clinical Pharmacology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Herston, Queensland, Australia
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Juviler P, Meyers JM, Levatino E, Axford J, Barker E, Correll L, Decker AS, Faria J, Gloff M, Loria A, McKenna M, Schriefer J, Stevens TP, Verna S, Wegman S, Wolcott K, Wakeman D. Reducing Unplanned Intubations in the Neonatal Intensive Care Unit After Children's Surgery: A Quality Improvement Project. J Pediatr Surg 2024; 59:45-52. [PMID: 37845122 DOI: 10.1016/j.jpedsurg.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Unplanned intubation following children's surgery is associated with increased postoperative mortality. In response to being a National Surgical Quality Improvement Program - Pediatric (NSQIP-P) high outlier for postoperative unplanned intubation, we aimed to reduce postoperative unplanned intubation events by 25% in one year. METHODS/INTERVENTION A multidisciplinary team of stakeholders was assembled in 2018. Most unplanned intubation events occurred in the neonatal intensive care unit (NICU). Based on apparent causes of unplanned intubations identified in case reviews, an extubation readiness checklist and a postoperative pain management guideline emphasizing non-opioid analgesics were implemented for NICU patients in September 2019. Postoperative unplanned intubation events were tracked prospectively and evaluated using quality improvement statistical process control methods. RESULTS Unplanned intubations in the NICU decreased from 0.27 to 0.07 events per patient in the post-intervention group (September 2019-June 2022, n = 145) compared to the pre-intervention group (January 2016-August 2019, n = 200), representing a 76% reduction. Postoperative opioid administration decreased significantly, while acetaminophen usage increased significantly over time. Balancing measures of postoperative pneumonia rate (1.5% vs 0.0%, p = 0.267) and median hospital length of stay [40 (IQR 51) days vs 27 (IQR 60), p = 0.124] were not different between cohorts. The 30-day mortality rate for postoperative patients in the NICU significantly declined [6.5% (n = 13) vs 0.7% (n = 1), p < 0.001]. CONCLUSIONS Postoperative unplanned intubation rates for NICU patients decreased following a quality improvement effort focused on opioid stewardship and extubation readiness. TYPE OF STUDY Prospective Quality Improvement. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Peter Juviler
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Jeffrey M Meyers
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Elizabeth Levatino
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Jessica Axford
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Barker
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Lynnie Correll
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew S Decker
- Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - John Faria
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Marjorie Gloff
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Loria
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Margo McKenna
- Department of Otolaryngology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jan Schriefer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy P Stevens
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Sarah Verna
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sarah Wegman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Kori Wolcott
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Derek Wakeman
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
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Brady BR, SantaMaria B, Ortiz Y Pino KT, Murphy BS. Opioid stewardship program implementation in rural and critical access hospitals in Arizona. J Opioid Manag 2024; 20:21-30. [PMID: 38533713 DOI: 10.5055/jom.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. DESIGN Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. SETTING Arizona critical access hospitals (CAHs). PARTICIPANTS ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments). MAIN OUTCOME MEASURES Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary). RESULTS The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD. CONCLUSIONS Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.
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Affiliation(s)
- Benjamin R Brady
- School of Interdisciplinary Health Programs, Western Michigan University, Kala-mazoo, Michigan. ORCID: https://orcid.org/0000-0003-3534-1027
| | - Bianca SantaMaria
- Health Education and Promotion Professional II, Arizona Center for Rural Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kathryn Tucker Ortiz Y Pino
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Bridget S Murphy
- Arizona Center for Rural Health, Comprehensive Pain and Addiction Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, on the lands of the O'odham and Yaqui peoples in Tucson, Arizona
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4
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McDerby N, Dawda P. Analgesic stewardship in Australian residential aged care facilities: Retrospective audit of a collaborative approach to optimising opioid use. Australas J Ageing 2023; 42:791-795. [PMID: 37198752 DOI: 10.1111/ajag.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/11/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To evaluate retrospectively an analgesic stewardship role of a non-dispensing pharmacist as part of a general practice team providing primary care services to residential aged care facilities (RACF). METHODS Our general practice implemented an analgesic stewardship program to optimise and monitor opioid usage for our patients located across 12 RACF in Canberra from March 2019 to September 2020. The primary objective was the development of a multidisciplinary chronic pain care plan to document treatment and monitoring strategies for optimising pain control. The pharmacist reviewed and documented existing pain management strategies in a care plan for each patient and discussed recommendations for optimisation with the general practitioner. The general practitioner implemented accepted recommendations and distributed finalised care plans to the RACF. A retrospective audit of care plans was undertaken to assess the outcomes: mean daily oral morphine equivalence to monitor opioid usage, and pain scores to monitor for any potential harm associated with analgesic stewardship. RESULTS One hundred and sixty-seven residents received an initial care plan. Residents were scheduled for a follow-up care plan after 6 months, which was achieved for 100 residents (60%). Scope for optimising opioid therapy was identified for 47 residents (28%) at baseline and 23 residents (23%) at follow-up. Mean opioid usage and pain scores were reduced at follow-up; 19.4 mg (SD 40.8) versus 13.4 mg (SD 22.8), and 4.2 (SD 2.3) versus 3.9 (SD 2.0), respectively. CONCLUSIONS A systematic, multidisciplinary analgesic stewardship approach may optimise pain management plans and reduce opioid usage in RACF residents.
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Affiliation(s)
- Nicole McDerby
- Prestantia Health, Canberra, Australian Capital Territory, Australia
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Paresh Dawda
- Prestantia Health, Canberra, Australian Capital Territory, Australia
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Next Practice Deakin, Canberra, Australian Capital Territory, Australia
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5
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DiScala S, Uritsky TJ, Brown ME, Abel SM, Humbert NT, Naidu D. Society of Pain and Palliative Care Pharmacists White Paper on the Role of Opioid Stewardship Pharmacists. J Pain Palliat Care Pharmacother 2023; 37:3-15. [PMID: 36519288 DOI: 10.1080/15360288.2022.2149670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Opioid stewardship is one essential function of pain and palliative care pharmacists and a critical need in the United States. In recent years, this country has been plagued by two public health emergencies: an opioid crisis and the COVID-19 pandemic, which has exacerbated the opioid epidemic through its economic and psychosocial toll. To develop an opioid stewardship program, a systematic approach is needed. This will be detailed in part here by the Opioid Stewardship Taskforce of the Society of Pain and Palliative Care Pharmacists (SPPCP), focusing on the role of the pharmacist. Many pain and palliative care pharmacists have made significant contributions to the development and daily operation of such programs while also completing other competing clinical tasks, including direct patient care. To ensure dedicated time and attention to critical opioid stewardship efforts, SPPCP recommends and endorses opioid stewardship models employing a full time, opioid stewardship pharmacist in both the inpatient and outpatient setting. Early research suggests that opioid stewardship pharmacists are pivotal to improving opioid metrics and pain care outcomes. However, further research and development in this area of practice is needed and encouraged.
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Hyland SJ, Wetshtein AM, Grable SJ, Jackson MP. Acute Pain Management Pearls: A Focused Review for the Hospital Clinician. Healthcare (Basel) 2022; 11:healthcare11010034. [PMID: 36611494 PMCID: PMC9818465 DOI: 10.3390/healthcare11010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Acute pain management is a challenging area encountered by inpatient clinicians every day. While patient care is increasingly complex and costly in this realm, the availability of applicable specialists is waning. This narrative review seeks to support diverse hospital-based healthcare providers in refining and updating their acute pain management knowledge base through clinical pearls and point-of-care resources. Practical guidance is provided for the design and adjustment of inpatient multimodal analgesic regimens, including conventional and burgeoning non-opioid and opioid therapies. The importance of customized care plans for patients with preexisting opioid tolerance, chronic pain, or opioid use disorder is emphasized, and current recommendations for inpatient management of associated chronic therapies are discussed. References to best available guidelines and literature are offered for further exploration. Improved clinician attention and more developed skill sets related to acute pain management could significantly benefit hospitalized patient outcomes and healthcare resource utilization.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, OH 43215, USA
- Correspondence:
| | - Andrea M. Wetshtein
- Department of Pharmacy, Cleveland Clinic Fairview Hospital, Cleveland, OH 44111, USA
| | - Samantha J. Grable
- Hospice and Palliative Medicine, OhioHealth Grant Medical Center, Columbus, OH 43215, USA
| | - Michelle P. Jackson
- Hospice and Palliative Medicine, OhioHealth Grant Medical Center, Columbus, OH 43215, USA
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Kim EJ, Hwang EJ, Yoo YM, Kim KH. Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it's time to act now. Korean J Pain 2022; 35:361-382. [PMID: 36175336 PMCID: PMC9530691 DOI: 10.3344/kjp.2022.35.4.361] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.
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Affiliation(s)
- Eun-Ji Kim
- Department of Pharmacy, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eun-Jung Hwang
- Department of Pharmacy, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yeong-Min Yoo
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Kyung-Hoon Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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8
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Forget P, Patullo C, Hill D, Ambekar A, Baldacchino A, Cata J, Chetty S, Cox FJ, de Boer HD, Dinwoodie K, Dom G, Eccleston C, Fullen B, Jutila L, Knaggs RD, Lavand’homme P, Levy N, Lobo DN, Pogatzki-Zahn E, Scherbaum N, Smith BH, van Griensven J, Gilbert S. System-level policies on appropriate opioid use, a multi-stakeholder consensus. BMC Health Serv Res 2022; 22:329. [PMID: 35277160 PMCID: PMC8917639 DOI: 10.1186/s12913-022-07696-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies. METHODS We conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level. We aimed to provide consensus statements for current developments and priorities for future developments. RESULTS Twenty-five experts from a variety of fields with experience in acute pain management were invited to join a review panel, of whom 23 completed a modified Delphi survey of policies designed to improve the safety and quality of opioids prescribing for acute pain in the secondary care setting. Strong agreement, defined as consistent among> 75% of panellists, was observed for ten statements. CONCLUSIONS Using a modified Delphi study, we found agreement among a multidisciplinary panel, including patient representation, on prioritisation of policies for system-level interventions, to improve governance, pain management, patient/consumers care, safety and engagement.
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Affiliation(s)
- Patrice Forget
- grid.7107.10000 0004 1936 7291Institute of Applied Health Sciences, Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, AB25 2ZD Aberdeen, UK
- grid.411800.c0000 0001 0237 3845Department of Anaesthesia, NHS Grampian, Aberdeen, AB25 2ZD UK
| | - Champika Patullo
- grid.416100.20000 0001 0688 4634Pharmacy Department, Queensland Opioid Stewardship Program, Clinical Excellence Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland 4069 Australia
| | - Duncan Hill
- grid.451104.50000 0004 0408 1979NHS Lanarkshire, Motherwell, ML1 2TP UK
| | - Atul Ambekar
- grid.413618.90000 0004 1767 6103National Drug Dependence Treatment Centre and Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Alex Baldacchino
- International Society of Addiction Medicine (ISAM), Valletta, Malta
- grid.11914.3c0000 0001 0721 1626Psychiatry and Addictions, University of St Andrews, St Andrews, Scotland
- grid.492851.30000 0004 0489 1867NHS Fife Addiction Services, Fife, KY16 UK
| | - Juan Cata
- grid.267308.80000 0000 9206 2401MD Anderson Cancer Center, University of Texas, Houston, TX 77030 USA
| | - Sean Chetty
- Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Cape Town, 8000 South Africa
| | - Felicia J. Cox
- grid.421662.50000 0000 9216 5443Pain Management Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Hans D. de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, van Swietenplein 1, 9728 NT Groningen, The Netherlands
| | - Kieran Dinwoodie
- grid.421126.20000 0001 0698 0044Chronic Pain, Modernising Patient Pathway Programme, Scottish Government, Edinburgh, UK
- Calderside Medical Practice, Blantyre, South Lanarkshire G72 0BS Scotland, UK
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681University of Antwerp (UAntwerp, CAPRI), Antwerp, Belgium
- Psychiatric Center Multiversum, 2530 Boechout, Belgium
| | - Christopher Eccleston
- grid.7340.00000 0001 2162 1699Centre for Pain Research, The University of Bath, Bath, BA2 7AY UK
| | - Brona Fullen
- grid.7886.10000 0001 0768 2743UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Liisa Jutila
- Pain Alliance Europe, Rue de Londres 18, 1050 Brussels, Belgium
| | - Roger D. Knaggs
- grid.4563.40000 0004 1936 8868School of Pharmacy, University of Nottingham, University Park, Nottingham, NG7 2RD UK
| | - Patricia Lavand’homme
- grid.48769.340000 0004 0461 6320Anesthesiology Department, Cliniques universitaires Saint-Luc, UCLouvain, 1200 Brussels, Belgium
| | - Nicholas Levy
- grid.417049.f0000 0004 0417 1800West Suffolk Hospital, Bury St. Edmunds, IP33 2QZ UK
| | - Dileep N. Lobo
- grid.415598.40000 0004 0641 4263Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Esther Pogatzki-Zahn
- grid.16149.3b0000 0004 0551 4246University Hospital of Muenster, Muenster, Germany
| | - Norbert Scherbaum
- grid.5718.b0000 0001 2187 5445LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Blair H. Smith
- grid.416266.10000 0000 9009 9462Ninewells Hospital and Medical School, NHS Tayside, University of Dundee, Dundee, DD2 4BF Scotland, UK
| | | | - Steve Gilbert
- Belford Hospital, Fort William, PH33 6BS Scotland, UK
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Hood A, Hemmann B, Chae S. Survey of Opioid Stewardship Practices in American Society of Health-System Pharmacists (ASHP) Post-Graduate Year 2 (PGY2) Pain Management and Palliative Care (PMPC) Pharmacy Residency Programs. J Pain Palliat Care Pharmacother 2021; 35:73-76. [PMID: 33955805 DOI: 10.1080/15360288.2021.1914282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
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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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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