Impact of a Pharmacy-Led Pain Management Team on Adults in an Academic Medical Center.

Background: Pain is a major health problem affecting more than 15% of adults in the United States. In a multidisciplinary pain management team, pharmacists can optimize pharmacotherapy quality by ensuring safe and appropriate medication use. Objective: Assess the impact of a pharmacy pain medication management service on pain-related outcomes in an adult inpatient population. Methods: This retrospective study evaluated patients who were admitted from November 2009 through November 2011 and received a pharmacy pain consult. Patients were excluded if they left against medical advice, their care was assumed by palliative care, or they had no complaint of pain when seen by the pharmacist. The primary outcome was the difference between each patient's average pain score from pre-consult to post-consult. Secondary outcomes were difference between each patient's average pain score from pre-consult to pre-discharge, overall functional improvement, pharmacist interventions, and 14-day and 30-day readmissions. Results: One hundred patients were included in the final analysis. Eight hundred twenty-one interventions were made by the clinical pharmacists. Patients displayed a significant reduction in their pre- and post-consult pain intensity scores on a 0 to 10 numerical rating scale (6.15 vs 3.25; p < .001). Likewise, a significant reduction in pain intensity scores was seen from pre-consult to pre-discharge (6.15 vs 3.6; p < .001). Overall functional improvement, specifically sleep, mobility, and appetite, was seen in 86.6% of patients. Conclusions: Pain management is an area that provides opportunities for pharmacotherapy interventions. Pharmacists' involvement in pain management on an inpatient consult service had a positive impact on pain scores and improvement in functionality.

The Effect of Patient Opioid Education on Opioid Use, Storage, and Disposal Patterns.

We evaluated the impact of patient education over opioid use, storage, and disposal on opioid handling patterns of palliative and chronic nonmalignant pain patients. We compared patient surveys before and after education and conducted further analysis for individual clinics due to group differences found prior to education. A total of 100 patients were included. After education, more patients reported never sharing their prescription opioid (95% vs. 66%; P < 0.01), and all reported awareness that one dose could be harmful to someone else (100% vs. 31%; P < 0.01). In addition, more patients reported locking their opioid for storage (85% vs. 13%; P < 0.01). Lastly, less patients reported leftover opioids (2% vs. 40%; P < 0.01), not always disposing (1% vs. 44%; P < 0.01), or purposefully saving (0% vs. 15%; P < 0.01), and all reported knowing the right way to dispose (100% vs. 14%; P < 0.01). Proper methods of disposal increased, including mixing with unpalatable substances (96% vs. 13%; P < 0.01) and utilizing drug-take-back programs (78% vs. 24%; P < 0.01). This project found that patient education improves knowledge and behavior related to opioid handling patterns. Further initiatives should help to identify higher-risk patients and develop educational tools.

Analgesic utilization before and after rescheduling of hydrocodone in a large academic level 1 trauma center.

BACKGROUND: Hydrocodone-containing products were recently rescheduled from Drug Enforcement Agency (DEA) schedule III to schedule II due to concerns of abuse and misuse. These changes went into effect on October 6, 2014. OBJECTIVE: This quality improvement project involved a retrospective analysis to determine the effect of the DEA schedule change on prescribing habits of hydrocodone-containing products as well as the remaining schedule III and IV opioids, codeine (schedule III) and tramadol (schedule IV). METHODS: The authors performed a medication use evaluation at our academic level 1 trauma hospital system on outpatient use of hydrocodone-containing products, tramadol, and codeine-containing products for 6 months before and 6 months after the change to schedule II using our electronic record and pharmacy system. RESULTS: A total of 88,428 prescription orders were analyzed. Comparison of prescriptions before and after the DEA schedule changes showed hydrocodone prescriptions reduced from an average of 225.97 per day to 1.20 per day. In addition, tramadol increased from 60.04 per day to 91.85 per day and codeine from 6.81 per day to 98.94 per day. CONCLUSIONS: Our data show a very substantial decrease in utilization of hydrocodone-containing products and concomitant increase in the utilization of tramadol and codeine products at our hospital after the DEA schedule change.