Hospital-based pharmacists spearhead opioid stewardship

In the nation’s fight against the opioid epidemic, pharmacists in hospital settings are on the front lines in detecting drug diversion and identifying ways to foster appropriate prescribing.

A new survey of pharmacy directors in more than 800 of America’s hospitals finds that most large health systems have active stewardship programs to prevent the misuse of opioids.

“Opioid stewardship programs are emerging in many U.S. hospitals, with pharmacists participating or taking the lead in program implementation,” according to the findings of the National Survey of Pharmacy Practice in Hospital Settings, published in the American Journal of Health-System Pharmacy.

The survey shows that most common strategies for preventing opioid misuse include providing clinician education and guidelines (71.4 percent), using prescription drug monitoring program (PDMP) database searches to track prescribing practices and patient behaviors that can lead to abuse (65.3 percent) and opioid diversion detection programs (55.6 percent).

PDMPs are electronic databases that help to track controlled substance prescriptions by flagging suspicious patient prescribing activities.

Also See: Opioid prescribing principles can help doctors fight the epidemic

When it comes to monitoring medications, a third of hospitals have pharmacists monitor all medication therapy, while 47 percent use electronic health records or clinical surveillance software to identify patients in need of additional pharmacist monitoring.

At the same time, fewer than 8 percent of hospitals in the survey—typically smaller hospitals—still use a paper-based screening process to identify patients whose medication should be monitored by pharmacists.

Strategies utilized to encourage appropriate prescribing include monitoring opioid prescribing practices to identify outliers among clinicians; leveraging clinical decision-support; imposing restrictions on specific opioids or doses; and providing daily feedback to prescribers.

“Hospital and health system pharmacists play a major role as patient care providers on the interprofessional team in managing medication therapy, educating patients and other providers, and helping to solve public health issues like the opioid crisis and drug shortages,” says Michael Ganio, an author of the study and director of pharmacy practice and quality at the American Society of Health-System Pharmacists.

“Pharmacists possess unique knowledge, skills and abilities that make them critical team members to help ensure that medication use is optimal, safe and effective,” adds Ganio. “That is why hospitals and health systems rely on them to take a leading role in addressing the opioid crisis and many other medication-related areas.”