Group meeting discussing their findings on the laptop.
HealthJuly 12, 2019

Key takeaways from the ASHP: Opioid stewardship and beyond

Summer is finally here, along with the ASHP annual meeting. Once again, I was fortunate to attend this annual event (in sunny Boston), see many pharmacy colleagues and friends, and gain perspectives on the state of pharmacy practice. The conference included the recurring topics of medication safety and ambulatory care as well as hosting official policy business via the ASHP House of Delegates. New this year was the area of Specialty Pharmacy, which is also the latest member of ASHP's "Sections". In a slight twist, the technology and informatics content (often independently featured at the meeting) was wisely integrated throughout the various educational sessions.

Opioid stewardship in the spotlight

While there were many great topics to choose from amongst all the education sessions, by the numbers, the hot topic was clearly opioid stewardship/pain management. In fact, the keynote speaker was Michael Botticelli, M.Ed, BA, Executive Director of the Grayken Center for Addiction at Boston Medical Center. Mr. Botticelli was the Director of National Drug Control Policy for the Obama Administration and joined the White House Office of National Drug Control Policy (ONDCP) as Deputy Director. He shared information on how the crisis began and emphasized the importance of destigmatizing substance abuse and addiction to bring about an end to the crisis.

Tips from the Joint Commission on pain management

In an update from the Joint Commission on "New Standards" Pain and Beyond, Jeannell Mansur, Principal Consultant, reviewed the elements of performance (EP) for the refreshed 2018 Pain Assessment and Management standards for a packed room. Dr. Mansur emphasized the need to consider the TJC tracer methodology and for appropriate staff to understand how the organization's pain assessment and treatment approach are represented in protocols, such as ensuring consideration of multimodal pain therapies. She also emphasized two key standards, EP56 and EP19, which address how the hospital collects data and monitors pain management and how opioid use is monitored from quantitative (prescribing rates) and qualitative (naloxone rescue events, safety risks) perspectives. Pharmacy can - and should - take a leadership role in these reporting EPs to ensure the organization has a continuous performance improvement system. At Wolters Kluwer Health, we are expanding Sentri7 reporting functionality to include an opioid stewardship dashboard that will support these standards. (Keep reading for more info) 

ISMP emphasizes opioid risks

Michael Cohen, President of ISMP and the godfather of medication safety, presented on "Looking over the Opioid Horizon Risks, Regulations and Possibilities." He emphasized that opioids have been and continue to be frequent offenders in patient safety events. Mr. Cohen made numerous recommendations around an issue that has been on my mind lately, "how do we notate in the EMR the patient's opioid status of naive vs. tolerant?" Many therapeutic decisions around opioid use depend on that consideration, yet there is no standardized method for including this information in the medical record or for clinical decision support applications. Mr. Cohen used the example of prescribing of fentanyl patches or long-acting opioids for opioid patients as an issue for concern. Real-time monitoring of patients at risk for opioid-related ADEs is critical, so we're developing new methods in Sentri7 for tracking and alerting around these avoidable harm events.

Empowering pharmacists to lead opioid stewardship

Surveys show that most health systems are in the early development stages with opioid stewardship and are seeking direction and tools to meet patient care needs. As such, we are committed to empowering pharmacists across a broad range of health care issues, including opioid stewardship and pain management. Sentri7 will provide real-time care management such as detecting patients at risk for opioid-related adverse events, identifying opportunities to de-escalate therapy and ensuring use of multimodal approaches to pain management. This will include powerful analytics that track opioid use by drug, drug class, service and prescriber as well as safety events related to opioids across single and/or multiple sites. Our vision is that our rules, workflow tools and reports support continuous quality improvement needs for opioid stewardship programs. The Sentri7 Opioid Stewardship Initiative will be initially available in late 2019.

ASHP emphasizes need for pharmacy accountability and leadership

In addition to opioid stewardship, the ASHP Summer Meeting featured multiple sessions on medication safety, antimicrobial stewardship, anticoagulation management, sterile compounding, and optimizing the role of technology in patient care and medication management. These are all critical components in the value that health system pharmacists support every day across the U.S. Earlier this month, the ASHP Pharmacy Accountability Measures Work Group, published an article in AJHP recommending 28 quality measures be considered for adoption by health systems pharmacy departments.1 Over 1000 performance measures underwent rigorous review and prioritization by subject matter experts to determine the final list.


The goal is for pharmacies to actively monitor and improve performance around these measures, which cover six key therapeutic categories: antithrombotic safety, cardiovascular control, glucose control, pain management, behavioral health, and antimicrobial stewardship. These measures "provide an opportunity for pharmacists to demonstrate accountability for performance, thus improving quality and safety and demonstrating the value of care provided."

I am proud to be a part of the "PAM" workgroup and hope many pharmacy organizations consider the adoption of some or all the measures. At Wolters Kluwer Health, we concentrate on and take these important professional issues to heart. Our goal is to help pharmacists take leadership roles in their organizations by empowering them with timely information and insights.


References:

[1] Mary Andrawis, L T C Christopher Ellison, Steve Riddle, Kurt (Charles) Mahan, Curtis D Collins, Philip Brummond, Jannet Carmichael, Recommended quality measures for health-system pharmacy: 2019 update from the Pharmacy Accountability Measures Work Group, American Journal of Health-System Pharmacy, Volume 76, Issue 12, 15 June 2019, Pages 874-887, https://doi.org/10.1093/ajhp/zxz069

Steve Riddle
Director of Clinical Development

Dr. Steve Riddle is a member of the product management team. He's responsible for the overall strategic direction for clinical content and the determination of business opportunities.

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