Category: Federal Forum Posters
Purpose: Opioids are often prescribed for post-operative pain management, and data demonstrates one in sixteen patients will remain on long-term opioid therapy. The 2016 Comprehensive Addiction and Recovery Act requires Veterans Affairs (VA) providers to conduct a risk assessment prior to opioid prescribing. This quality improvement project aims to evaluate the impact of pharmacist-performed database reviews and recommendations for individualized risk mitigation. The VA Stratification Tool for Opioid Risk Mitigation (STORM), state prescription drug monitoring program (SPDMP), and urine drug screen (UDS) will be evaluated prior to opioid prescribing for acute pain in patients undergoing total hip and knee arthroplasty.
Methods: During the first phase of this project, September 2018 through January 2019, nurse practitioners will order a UDS in addition to standard pre-operative labs for patients at the time of the history and physical. Pharmacists will evaluate results and offer individualized safety recommendations to the providers. Pharmacists will also perform a STORM review and California SPDMP report for scheduled post-surgery discharges and document findings and recommendations for each patient in the electronic medical record (EMR). Individualized recommendations will include: offering opioid education and naloxone kits, reduced post-operative opioid day supply, medication disposal bags, and pain management and substance use disorder specialist consultations. Recommendations will be communicated to prescribing nurse practitioners via notification in the EMR. Time spent to perform and document database reviews will be evaluated, and baseline patient demographics collected. During the second phase of the project, January through March 2019, pharmacists will perform a two-month post-discharge EMR review for each patient to evaluate: type and number of implemented recommendations by providers; quantity, day supply, and number of patient-requested opioid refills. Descriptive statistics will be utilized to analyze collected data.
Results: not applicable
Conclusion: not applicable
Mahsa Malakootian– PGY1 Pharmacy Practice Resident, San Francisco Veterans Affairs Health Care System, San Francisco, CA