Develop an opioid stewardship toolkit to implement, measure, and monitor your program

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 faced 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 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, which can be done through the internal data analytics program.

Taking advantage of the ability to develop user-friendly dashboards within Sentri7 Pharmacy 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 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 throughout the whole system. Equally important, users can look at the rules they’ve created in the application for real-time concerns.

Refining an opioid stewardship program

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

Their ability to intervene is aided by the application’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 Pharmacy 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 application rules.

A holistic opioid stewardship process

This article focuses on using a clinical surveillance tool like Sentri7 Pharmacy to develop an opioid stewardship toolkit, 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, are 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.