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

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.

Evaluation of Broad Skill Repertoire Changes Over 3 Months of PEAK Implementation in a Special Education Classroom.

The Promoting the Emergence of Advanced Knowledge (PEAK) Relational Training System provides a comprehensive language and cognition training strategy for use with children with disabilities. In the present study, we conducted PEAK within a special education classroom over the course of 3 months, and language and cognitive skills were assessed using the PEAK Comprehensive Assessment (PCA). On average, each of the five participants mastered 11.2 target programs across PEAK modules with an average of 186.4 new verbal behaviors or supporting behaviors. All participants showed an increase on the PCA following the intervention, with an average increase of 39.6 correct responses, and parents and staff reported improvements in participants' use of language at home and at school relative to prior semesters. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-021-00657-6.

Developing Remote Delivery of Language and Cognitive Training for Use With Children With Autism: A Technological Report.

Remote delivery of language and cognitive training is becoming increasingly prevalent within special education settings, and the recent COVID-19 pandemic has challenged many providers to pivot to telehealth models. This technical article outlines a procedure for developing computerized discrete-trial training programs using commonly available software, as well as a description of how to adapt this strategy to teach chained tasks remotely. Within this article, we describe how to establish unidirectional and bidirectional remote interfaces to work directly with learners. Finally, we conducted a field test of these approaches with programs adapted from two standardized curricula: PEAK and PRISM. We conclude the article by discussing barriers and potential solutions that we observed while field-testing these procedures within special education settings in response to the wide-scale emigration to remote teaching due to the COVID-19 pandemic. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40617-020-00544-6.

Synthesizing the Multiple-Probe Experimental Design With the PEAK Relational Training System in Applied Settings.

The scientist-practitioner model necessitates embedding experimental designs within applied practice. This technical report describes a procedure for embedding a multiple-probe experimental design within the PEAK Relational Training System across all four PEAK modules. Baseline probes provide a direct test of target skills negatively endorsed within the PEAK assessment battery and can provide an estimate of skill acquisition in the absence of direct training. Temporal staggering of the probes maintains the fidelity of the experimental design and allows for the design to evolve along with learner skill acquisition. Achievement of mastery criteria demonstrates the efficacy of programming, and failure to achieve mastery can be remedied through programming adjustments that can be captured within the design. We additionally conducted a field test of the design with a child with disabilities, supporting the viability of this procedure within applied settings.