How Pharmacists Can Lead an Opioid Exit Plan

A paper in JAPhA highlights the important role pharmacists can play in leading an opioid exit plan (OEP).

The paper, “Opioid exit plan: A pharmacist's role in managing acute postoperative pain,” is a case study of how the pain management team at St. Joseph Mercy Hospital in Ann Arbor, MI, operates. St. Joseph’s developed a pharmacist-led OEP that has been successful in helping to manage postoperative pain and provide patient education.

At St. Joseph’s, the OEP program is staffed by trained and student pharmacists, as well as a clinical pain management pharmacist, and each surgery area is staffed by one pharmacist.

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Statistics from St. Joseph show that 75% of patients who undergo surgery experience moderate to severe post-operative pain; patients who receive an opioid prescription within seven days of surgery are 44% more likely to still be using the medication one year after surgery than those who did not receive an opioid prescription.

To develop the OEP for each patient who is identified as opioid tolerant, a pharmacist develops a personalized inpatient pain plan through a quick phone call before surgery. After surgery, all opioid-tolerant patients are put on a personalized, multimodal postoperative treatment. Opioid-naïve patients receive a standardized multimodal postoperative-pain order set. The pharmacist-led team then make interdisciplinary rounds to monitor the therapies and intervene where needed.

Once a discharge order is written for a patient, the team reviews pain medication doses the patient received in the previous 24 hours to create an outpatient pain management plan. The pharmacist explains to prescribers the reasoning behind the recommendations based on the patient history from the PDMP search conducted on each patient, the preoperative interview, and the final-24-hour doses. The patient then receives the OEP as a part of their discharge documentation.

The team is then involved with discharge counseling, which is often performed by the student pharmacists. This counseling involves information on how to safely manage pain, as well as an opioid discontinuation plan designed to taper opioid use over time. Patients are given information about the effects of remaining on opioids for too long and about withdrawal symptoms. Patients are also given information on how to properly dispose of opioids, a training that 92% of patients who are prescribed opioids do not receive.

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Because pharmacist-led OEPs are rare, little information is available on their efficacy. However, though hard data is lacking, the authors, led by Cheryl Genord, BSPharm, Clinical Pain Management Pharmacist, St. Joseph Mercy Hospital, suggest that “a pharmacy pain management team can be key to guiding the appropriate prescribing practices of inpatient opioids and ensure best practices with quantity and quality of opioid prescriptions written on discharge.”

“Pharmacists can fill an important gap,” the authors write, “in the prevention of chronic opioid use by integrating themselves into their institution's pain management teams.”