HealthMarch 22, 2024

How to implement, measure, monitor, and refine your opioid stewardship program

Boost opioid stewardship program investments by empowering pharmacists and health system leaders with clinical tools for opioid use visibility.

Even today, years after the human and financial costs of the opioid crisis became apparent, the country continues to struggle to find a way out. Hospitals and health systems are trying to do their part with opioid stewardship programs, but the challenge is complex, and having a substantive impact can be elusive. 

A recent survey revealed that nearly two-thirds of health system respondents had increased their investments in opioid stewardship over the past year. Educating providers and the public, implementing alternative pain management approaches, placing limits on doses and quantities, performing drug diversion investigations, and leveraging technology to help monitor prescriptions are all priorities. 

In many cases, the increased investments are buttressed by an emerging understanding of what makes an opioid stewardship program successful. 

Three elements are particularly important in creating a tightly managed, strategically informed approach

Trust and support

Successful programs garner buy-in throughout the health system by building trust among the many stakeholders needed to address this challenge. Having senior leadership’s full support is particularly important for building that trust. 

Pharmacy leadership

Successful programs also know how to take advantage of the skill set of clinical pharmacists. Giving those pharmacists the resources and support needed to drive effective change is essential. 

A powerful clinical surveillance tool

Equipping pharmacists and health system leadership with a powerful clinical surveillance tool that creates the necessary visibility into opioid use and the health system’s mitigation efforts is the central piece of implementing, monitoring, measuring, and refining a successful program.

This article drills down into the third element, using Steward Health Care’s opioid stewardship program as an example.

Setting up an opioid stewardship program for success

Steward is the largest private, tax-paying healthcare network in the United States, with 33 hospitals, more than 25 urgent care centers, 107 preferred skilled nursing facilities, and more than 7,900 beds to manage across eight states. After addressing the first two elements of a successful program, Steward wrote and integrated a number of critical opioid stewardship rules into its existing Sentri7 clinical surveillance tool. Steward chose Sentri7 because of its powerful data capture capabilities and robust analytics that interact effectively with the health system’s EHR.

Steward based its rules and their corresponding metrics on the American Hospital Association’s Stem the Tide project. That project asserts the ideal metrics for opioid stewardship:

  • Address a problem in the hospital/health system or community
  • Support efforts with up-to-date and evidence-based internal guidelines, policies, or procedures
  • Show success or a need for improvement with established goals and are longitudinal
  • Identify variations between departments, units, or prescribers
  • Guard against any unforeseen consequence with effective countermeasures
  • Recognize meaningful outcomes in acute pain management
  • Reduce opioid overuse, misuse, and adverse events in acute care settings

These principles translate into ensuring your clinical surveillance tool for opioid stewardship can effectively offer elements that include:

  • Readily available, real-time, milligrams morphine equivalent (MME) scores
  • Efficient, real-time identification of opioid-related intervention opportunities
  • Easily accessed opioid stewardship interventions for all pharmacy staff

In a webinar with Steward Health Care, Steward shared how they successfully established a robust opioid stewardship program across facilities in the health system. Access the webinar to learn more and continue reading for highlights and key takeaways.

Access The Webinar

Striking a balance: Rule implementation and workflow optimization

Steward’s initial focus was on the inpatient population across its 33 hospitals. As it began to consider specific rules, it confronted a key initial challenge: which rules and how many? That, of course, is a delicate balance, as the rules must be broad or sensitive enough so as not to miss any important intervention opportunities, but narrow or specific enough that alarms and reminders don’t overwhelm the pharmacy staff’s workflow.

Creating the right balance involves engaging with pharmacy staff all along the way to develop and pilot an initial set of rules. Then, before rolling out the initiative across all locations, make any necessary adjustments after following two important steps. First, check back in with the pharmacist team for any emerging questions or concerns. Second, closely evaluate the quality of the hits the rules generated and the degree to which people engaged with the rules and took appropriate action. This may be accomplished with an internal data analytics program.

Taking advantage of the ability to develop user-friendly dashboards within Sentri7 helps any effort to easily view these success factors in a timely manner. The dashboards, which update each morning, offer visibility into usage and safety trends for both the entire system and individual sites with the ability to view data for specific date ranges, locations, and individual drugs. Among other things, it offers all stakeholders the ability to benchmark individual sites against the whole system, or against similar sites in the whole system. Equally important, for real-time concerns, users can look at the rules they’ve created in Sentri7. 

Refining an opioid stewardship program 

Though any initiative needs time to settle in, it’s important from the outset to begin measuring how the initiative is working. For example, one measure for Steward is how their frontline pharmacists are responding to the rules in Sentri7 over time. How often are they intervening and how quickly? 

Their ability to intervene is aided by Sentri7’s ability to use suggested actions to instill confidence in those frontline pharmacists. This enables the health system to dig deeper and check in with those pharmacists to understand how comfortable they are speaking with providers. What barriers are they encountering in enforcing rules? Understanding elements like these provides genuine insight into why a program may or may not be meeting expectations. 

Having that understanding is not enough. You need a process for making refinements, implementing fixes, and expanding the program as necessary. Steward views this as a continuous process with three core elements:

  • Implement: Roll out the program 
  • Prepare: Gather feedback from sites, determine gaps in current rules, and develop an audit tool
  • Refine: Pilot changes, analyze the data, modify as needed, then back to a full roll-out 

A Steward Sentri7 Steering Committee oversees the process and the various opioid stewardship roles. Any ideas or issues come to the committee, which identifies opportunities for further refinement and works with site champions to implement desired changes in both the process and the Sentri7 rules. 

A holistic opioid stewardship process

This article’s focus has been on how to use a clinical surveillance tool like Sentri7 to optimize your opioid stewardship program, but it’s important to remember it is only one of three core elements for success. Staying on top of the other two components – building trust and support, and empowering pharmacists – is equally important. At a time when the opioid crisis continues to challenge health systems and the communities they serve, deploying an effective opioid stewardship program has never been more important.

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Rich Dion PharmD
Pharmacy Clinical Program Manager

Dr. Richard Dion has 15 years of experience in the practice areas of medication use safety, pharmacy informatics and clinical decision support in varied settings.

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