Implementation of a pain medication stewardship program

Abstract

Pain medication stewardship is important to pharmacy practice because of its impact on quality patient care and medication safety. The Joint Commission recently published a Sentinel Event Alert on opioid safety suggesting that hospitals create and implement policies and procedures for a second-level review of pain management plans with high-risk opioids by pain specialists or pharmacists.1 A pain medication stewardship pharmacist would fulfill this role and enhance patient safety. In this article, we describe our experience with the development of such a program, which was created to bridge the gaps between pain management services provided by multiple disciplines within our institution, an academic medical center with more than 600 staffed beds. In November 2009, an interdisciplinary pain steering committee was created to identify barriers to improving patient satisfaction with pain management. The committee comprised representatives from various departments, including anesthesia, physical medicine and rehabilitation, surgical services, inpatient pain management consultation team, palliative medicine, pharmacy, and nursing. One of the major health care gaps identified was that while our institution had five consultation services for different types of pain management, there was no accountability for any one service to address the needs of the patient population as a whole. The committee championed recommendations to restructure the pain management services under the coordination of a medical director and through collaboration with other departments, including nursing and pharmacy. Recommendations specific to pharmacy included monitoring analgesic medications for safe use and providing evidenced-based prescribing guidelines through the enhancement of order sets and clinical services.