Assessing the Effectiveness of a Consultant Pharmacist-Led Opioid Stewardship Protocol in Skilled Nursing Facilities.

Abstract

Background More than 1.4 million adults in the United States live in skilled nursing facilities (SNFs). Opioids are prescribed to approximately 60% of skilled nursing residents, a primarily older patient population. Current opioid prescribing guidelines may be difficult to extrapolate to this population because of pain burden and extensive analgesic use. Furthermore, in the older population, opioids are associated with greater frequency of adverse events with potential for hospitalization and increased all-cause mortality. Objective Evaluate the impact of a consultant pharmacist-led opioid stewardship protocol on patient pain-related outcomes in SNFs. Methods An opioid medication management protocol was implemented by consultant pharmacists at participating SNFs. Consultant pharmacists assessed facility residents for active opioid orders and systematically evaluated use and appropriateness of therapy. Facility data pre- and post-implementation of the protocol was compared to determine effectiveness. The primary outcomes included rate of recommendation acceptance, rate of as-needed (PRN) opioid utilization, and number of residents who experienced a fall. Results A total of 114 patients were included in the study. The percentage of patients utilizing opioid therapy pre-intervention was 78.1% and 74.6% post-intervention (P = 0.29; 95% CI 0.033-1.864). Patient pain scores decreased from an average of 3.7 to 3.2 (P < 0.01). Use of PRN opioid orders transitioned from 84.2% to 71.9% (P = < 0.01; 95% CI 0.055-0.675). Conclusion This study revealed significant reductions in average patient pain scores and reduction in PRN opioid medication utilization, overall emphasizing the positive impact of consultant pharmacist involvement in opioid stewardship within the skilled nursing setting.