2025 Southeastern Residency Conference

Title: Evaluation of Pharmacist-Led Opioid Stewardship Efforts in a Community Hospital 
Authors: Mia Passarelli, Amanda Herndon, Keith Johnson 
Background/purpose: Acute pain is a primary driver of hospital admissions in the United States, with opioids remaining the most used analgesics for management. However, the rise in opioid prescribing and consumption has significantly contributed to the ongoing opioid crisis. To address these concerns, the Centers for Disease Control and Prevention guidelines highlight the need for responsible opioid prescribing to reduce associated risks. Research on pharmacist-led opioid stewardship programs has shown improvements in both the safe and effective opioid utilization. This study seeks to evaluate the impact of pharmacist-driven opioid stewardship interventions on pain management safety and efficacy within a community hospital setting.   
Methodology: This study received Institutional Review Board exemption. Utilizing a quasi-experimental, retrospective, comparative design, this study evaluated opioid stewardship practices before and after the implementation of a pharmacist-led opioid stewardship protocol. Upon receiving opioid orders, pharmacists performed a comprehensive chart review to assess the need for medication-related interventions in accordance with a locally approved protocol. This review excluded orders for patients with chronic pain, cancer pain, those receiving palliative or hospice care, as well as cases involving acute postoperative pain and ischemic chest pain. This protocol served as a framework for selecting opioid analgesics and adjunctive therapies, ensuring a comprehensive approach to pain management. Pharmacists implemented a range of interventions, including converting intravenous opioids to oral formulations, adding analgesic orders for lower pain scales if omitted, prescribing naloxone for patients receiving more than 50 morphine milligram equivalents (MME) daily, and initiating bowel regimens for patients on scheduled opioid therapy. All pharmacist interventions were documented. The primary outcome was adherence to appropriate pain scale, defined as correspondence between the patient-reported pain scale and the administered medication’s ordered pain scale. Secondary outcomes included the incidence of analgesic order panel utilization, the incidence of oral opioid administration, incidence of methylnaltrexone administered for opioid induced constipation, and naloxone administration rates following the administration of an opioid analgesic.   
Results: A total of 2,878 patients were included, 1,419 in the pre-intervention group and 1,459 in the post-intervention group. For the primary outcome of incidence of adherence to appropriate pain scale, 77.9% of administrations were considered adherent in the pre-intervention group and 89.2% in the post-intervention group p < 0.001). Compared to the pre-intervention group, the incidence of analgesic order panel utilization was higher in the post-intervention group (25.5% vs. 38.2%; p < 0.001). The incidence of naloxone administration did not differ significantly between the pre- and post-intervention groups (0.21% vs. 0.14%; p = 0.63). Incidence of methylnaltrexone administered for opioid induced constipation occurred in 0.41% of the post-intervention group compared to 1.13% of the pre-intervention group (p = 0.02). Of all opioid administrations 60.01% were oral opioids in the post-intervention group compared to 63.27% in the pre-intervention group (p < 0.001).
Conclusions: The pharmacist-led opioid stewardship protocol significantly improved the adherence to appropriate pain scales and the utilization of available order panels. The protocol effectively implemented the initiation of bowel regimens, limiting the requirement for opioid induced constipation treatment.